Personalizing Your Health-Care Management Program
Over a period of five years, as best she could date the onset of her misery, Diana gained forty pounds, despite trying every diet known to man, and acquired doctors’ prescriptions, one after the other, for a total of six medications per day. Asked how she felt, she could answer you in one word: “Lousy.” She could also expand the answer to embrace a number of complaints, including no energy at all and a diminishing enthusiasm for life. Asked to what she attributed her weight gain, ill health, and depression, she offered another one-word answer: “Menopause.”
After five years of decline, she caught the flu just as winter set in, and it knocked her down completely. Although the infection was eventually zapped by rest, fluids, and symptom-controlling medicines, Diana remained ill throughout the winter. Even spring offered no jump of resilience to snap her back. All the symptoms that had bothered her before the flu now simply seemed worse, and she despaired of ever feeling well again.
The straw that broke the camel’s back and sent Diana to a functional medicine practitioner was that her hair started falling out. Fast. She couldn’t help her reaction: Stupefied at finding herself clutching a handful of hair, she burst into tears. “What is happening to me?” she sobbed, “and why can’t someone fix it?”
Diana sought out one of the physicians in our group at the Functional Medicine Clinical Research Center here in Seattle and was given a full functional medicine evaluation. The conclusion was that she had a significant imbalance in her detoxification and defense processes and needed a personalized program that would be layered onto the diet and dietary supplement components of the baseline program to address those core imbalances. Of particular importance also was the mindfulness-focused cognitive behavioral training; this was key to managing the stress that both Diana and her functional medicine practitioner felt was a significant contributor to her core imbalances. Here are some of the modifications in Diana’s personalized plan.
• A low-allergy food plan with increased vegetable protein—plus a rice protein supplement—and increased levels of vegetables, especially of the cruciferous family, containing phytonutrients that specifically support detoxification
• Increased water intake of at least six 8-ounce glasses per day
• A supplement of sodium bicarbonate daily to augment alkaline reserve
• An inulin prebiotic and a high-potency probiotic
• A tailored nutritional supplement program delivering specified levels of vitamins, minerals, and phytonutrients to support the detoxification process, including:
A balanced B-vitamin complement with increased amounts of folic acid, vitamin B12, pantothenic acid, biotin, and the trace mineral zinc
A phytonutrient supplement composed of concentrates from broccoli and brussels sprouts as well as a supplement of N-acetylcysteine to support glutathione needs for the detoxification process
Diana saw and felt little progress in the first month of this program, and she questioned whether it was worth the effort. By the sixth week, however, she began to realize that she was feeling better; above all, she noticed that the hair loss had stopped and that new hair was growing back into places where it had thinned considerably. This was sufficient encouragement for her to stick with her program; by twelve weeks she could record enough progress that she felt and looked like a “new woman”—her phrase.
She felt so much better, in fact, that she adhered to the program for six months in all. By then, she had lost more than thirty-five pounds, was taking only two daily medications, had a full head of hair, and was wearing clothes she had not worn for seven years. Her cloud of depression had also lifted; Diana felt a renewed zest for living.
She and her physician now adjusted her personalized health-management program to reflect her new condition, giving her greater latitude in her food choices and a lower level of nutritional supplementation. That was six years ago as I write this, and Diana remains a woman of high energy and great stamina, powers present in her genetic makeup that had been dampened by the specifics of her gene-environment interaction and that were unlocked by her personalized health management intervention and her ongoing health-management program.
No book can evaluate you and pinpoint your most significant process imbalance, as her physician did for Diana. No book can design a personalized health-management program for you to the level of detail of Diana’s program. What this book can do—and what we will do in this chapter—is provide planning tools that can help shape your analysis so you can draw the right insights from your own observations and self-assessments. Just as you look for patterns in which you observe and assess, this chapter shows you some of the patterns typical of imbalances in each of the seven core physiological processes—and it suggests ways to restore balance to each system, and therefore to the body’s systems network as a whole. A more detailed guide to additional resources—professional help from a practitioner trained in functional medicine, for example, or access to coaching, support, or additional information—will be provided in Appendix C, “Resources.”
One of the tools that you may want to avail yourself of—and one that will be further discussed in Appendix C—is genetic testing, now available commercially, although not in all states. You basically submit a saliva sample and get back an analysis of your DNA. In getting to know your genes, you’ll also find out where the risks are so that you can take steps now to avert or avoid those risks. This is a highly sophisticated and important tool, priced to be accessible, and well worth it.
WHERE’S THE IMBALANCE?
For now, however, it’s time to turn to the self-assessment questionnaires and identify where your imbalances may be so that you can get to work doing something about them.
You’ll begin by evaluating the answers you gave to the health self-assessment back in the Introduction. The aim is to get an idea of where the imbalances are and how bad they are.
This is not a diagnosis. That’s a concept belonging to the “old” medicine of infectious disease. Diagnosis looks at symptoms in order to prescribe ways to combat them. What you’re looking for in preparing your personalized health-management program is patterns in your physiological functioning—all together and process by process—so that you can begin to affect the underlying causes of the chronic illnesses that may be diminishing the quality of your life today or threatening your future health and well-being.
I would add one more important point—not so much a medical concept but equally important as a tenet of this new way to address your health. Precisely because what you are about to develop is a personalized health-management program, there is no room in it for any finding of blame or guilt in your interpretation of your self-assessments. The idea that we have “done something wrong” or “done this to ourselves” is foreign to every impulse of medicine and has no place in the world of health. Rather, what you’re doing is seeking long-term improvement in health and function by applying revolutionary discoveries in health to your own needs, desires, and health status. It’s a good thing to do.
So here again is the Health Self-Assessment Questionnaire you first saw in Chapter 1. See if your answers are still the same.
Take an interactive version of this assessment online at q.hc.com/dd/1
MY HEALTH SELF-ASSESSMENT
1. Do you feel that your health has gotten worse over the past two years?
2. Have you lost or gained more than 10 percent of your body weight over the past five years—even though you weren’t intentionally dieting?
3. Do you have trouble going to sleep or staying asleep?
4. Does pain in your joints or muscles limit your physical activity or mobility?
5. Do you commonly feel fatigued for no apparent reason?
6. Are you frequently depressed or anxious?
7. Do you have problems with memory?
8. Is there a consistent ringing in your ears?
9. Do you feel that you are losing your strength?
10. Do you take more than two prescription medications?
11. How about over-the-counter medications? Do you commonly take any of these?
a Anti-inflammatories
b Antacids
c Analgesics
d Sleeping remedies
12. Do you suffer from allergies?
13. Do you occasionally have episodes of poor concentration or confusion?
14. Do you commonly suffer from shortness of breath or feel winded?
15. Have you lost any of your sense of taste or smell over the past few years?
16. Do you feel that you have lost significant amount of muscle mass over the past few years?
17. Have you heard from your doctor that you have any of the following?
a Elevated blood pressure
b Elevated blood cholesterol
c Elevated blood glucose
18. Has your dentist told you that you have gum or periodontal disease?
19. Do you frequently alternate constipation and diarrhea or feel pain or discomfort in your digestive area?
20. Have you been told that you have chronic bad breath?
21. Are you shorter than you used to be, or have you any evidence of calcium deposits?
22. Do you catch every cold and flu that’s going around?
On a piece of paper, list the numbers of the questions to which you answered yes. If you answered yes to the majority of questions, it is likely you have multiple imbalances in your core physiological processes. Focus specifically on questions 1, 2, 3, 10, 11, 17, and 22. Did you answer yes to all or most of these? If so, that’s a strong indication of multiple imbalances in your core physiological processes.
What is significant about these seven questions? Six of them—2, 3, 10, 11, 17, and 22—are fairly standard signals of lack of overall well-being and suggest you have some imbalances in your core physiological processes. Yet the very first question, asking if you feel your health has gotten worse over the past two years, has been identified in numerous studies to be one of the most important early-warning indicators of core imbalance. The reason? Most people are a lot more attuned to their health than they realize. While we may block out of our consciousness those issues we don’t want to deal with—like signals of ill health—our subconscious keeps track of such issues, and the result is often a general feeling of deteriorating health.
Feelings need to be backed up by data, however, as the scientist in me rushes to add. The best way to pinpoint areas of imbalance before they become troublesome is to track the trajectory of your health, and the best way to do that is to record such standard blood biomarkers as cholesterol, PSA for men, blood sugar, hemoglobin A1c, uric acid, calcium, and triglycerides—among others—on an annual basis. Studies make it clear that it is when the values of blood biomarkers start to change rapidly that you’re in trouble. A general feeling of malaise will show up in hard data, if you are conscientious about getting the tests done every year.
What do your other questionnaire answers tell us? Here is how the yes answers to the health self-assessment questions match up against the core physiological processes. If you checked even some of the yes answers for a core process, you are likely to have an imbalance in that process. If you checked all, you certainly do.
| Yes Answers | Core Physiological Process | |
| 2, 4, 9, 12, 13, 15, 16, 19, 20 | Assimilation-elimination | |
| 2, 3, 4, 7, 8, 12, 13, 20, 22 | Detoxification | |
| 4, 6, 8, 12, 13, 16, 18, 19, 20, 22 | Defense | |
| 2, 3, 4, 6, 15, 18, 22 | Cellular communications | |
| 2, 3, 4, 6, 15, 17, 18, 21 | Cellular transport | |
| 2, 4, 5, 7, 9, 13, 14, 16 | Energy | |
| 2, 3, 4, 14, 16, 21 | Structure |
Now rank the process imbalances by the percentage of yes answers for each. Obviously, for example, four yes answers out of a possible six shows a worse imbalance than five yes answers out of a possible ten.
Of course, as you have learned, all the core physiological processes are interconnected in the network of systems that is your body, so an imbalance in one is likely to affect an imbalance in another. Nevertheless, pinpointing the most significant imbalance offers a starting point for the design of your personalized program. Think of it as a first cut at understanding your genome, a first draft of insight into the genes writing your book of life.
BEGINNING TO CHANGE THE MESSAGE
So now let’s get specific. The core process self-assessments let you zero in on any and all processes where you show an imbalance. You’ll want to consult with your functional medicine practitioner about specifics for dealing with your imbalance—depending on its severity and other factors—but here are some general recommendations for getting started.
Take an interactive version of this assessment online at q.hc.com/dd/2
ASSIMILATION-ELIMINATION
1. Do you alternate between constipation and urgency?
2. Do you get indigestion?
3. Does your stool have an oily appearance?
4. Do you suffer from frequent intestinal gas or bloating?
5. Is stomach or intestinal pain a regular occurrence?
6. Do you frequently get gastric reflux?
7. Are headaches a common occurrence?
8. Are you allergic or sensitive to many foods?
9. After eating, do you find you experience joint or muscle pain?
10. Do you have bad breath?
11. Are you depressed or subject to mood swings?
12. Do you have trouble keeping your weight under control even though you watch your diet?
13. Is your blood sugar elevated?
14. Do you suffer from kidney stones?
15. Is your blood pressure higher than it should be?
Five or more yes responses to the questionnaire for Chapter 4 suggest an imbalance in your core physiological process of assimilation-elimination. Restoring balance in the process is the precise aim of the Four R Program, which is a commonsense approach to most health problems in this area, but a number of specific conditions warrant particular mention.
Indigestion is certainly one of the most common complaints arising from an imbalance in this core process—an everyday occurrence that prompts those experiencing it to prowl drugstore aisles looking at shelf upon shelf of antacid medications. Indigestion may well have elicited a positive response to question 2 in your self-assessment questionnaire for this subject. Typically, what’s at issue is an upper intestinal problem in the stomach associated with what is called gastroesophageal reflux disease, or GERD. If it is a frequent occurrence, chances are that particular foods are triggering the response, so identifying the trigger foods is essential.
Be aware, however, that indigestion could indicate an enzyme deficiency, easily resolved with a digestive enzyme supplement, or could even signal an infection from the food-borne bacteria Helicobacter pylori.
Oily stool, asked about in question 3, is an indication that the fats you ingest are not being well digested—possibly as a result of the pancreas secreting insufficient digestive enzyme or the gallbladder releasing insufficient bile—and you might want to lower the amount of fat in your diet. But be alert to the fact that both of these causative factors can be an early sign of gallstone formation and poor assimilation of essential fatty acids and fat-soluble vitamins. It’s therefore a symptom to be taken very seriously.
If you answered yes to the questions concerning headaches, intestinal pain after eating, bad breath, or mood swings—7, 9, 10, 11—you may be sensitive to such foods as dairy products, grain products, sugared foods, and foods high in saturated fat or fried foods. If so, you probably want to consider solutions that help you maintain a healthy balance of enteric microflora.
Balance throughout your assimilation-elimination process also reestablishes proper immune balance—remember that the intestinal tract is the seat of your immune system—and this fact underlies the Four R Program. Keep in mind that while the four steps of the program can be executed simultaneously, it may take up to four weeks to experience the program’s full benefits.
Here’s a recap of the Four R Program: Remove, Replace, Reinoculate, Repair.
Start by identifying foods you may be sensitive or allergic to. The best way to do this is to eliminate a food you suspect for a period of two weeks to see if your symptoms improve. That may sound laborious, but studies show that most of us consume more than 80 percent of our calories in fewer than fifteen foods, so it’s less laborious than you think. Then follow the first R of the program and remove these foods from your diet. In general, you probably would do well to avoid foods or beverages that contain high-fructose corn syrup sweetener as well as foods in which sugars, fat, and salt are key ingredients.
The second R, replace, seeks to put back into your core assimilation-elimination process what it needs to digest fat and protein easily. On a Mediterranean diet, this will be less of a problem since this way of eating is reasonably low in fats. If you seek a digestive enzyme supplement, look for those derived from porcine sources that are high in chymotrypsin and lipase activity; the former helps the breakdown and therefore the digestion of protein, the latter of fat.
Reinoculate, the third R of the program, means adding prebiotic and probiotic supplements to improve the assimilation-elimination process. The prebiotics act as food for the probiotics, which in turn help the digestive process—a perfect example of a symbiotic relationship from which your body benefits.
Finally, the fourth R repairs the process through the use of specific nutrients that strengthen the gastrointestinal barrier and support intestinal transport of water and thus elimination.
FOR AN IMBALANCE IN THE ASSIMILATION-ELIMINATION PROCESS
| If You Answered Yes to . . . | Try This . . . | |
| 5 or more questions | Four R Program | |
| Question 2 | Identify trigger foods of GERD | |
| Question 3 | Less fat | |
| Questions 7, 9, 10, 11 | Supplements to balance microflora |
Take an interactive version of this assessment online at q.hc.com/dd/3
DETOXIFICATION
1. Are you sensitive to fragrances and odors?
2. What about food—any sensitivities?
3. Sensitive to particular medications?
4. To alcohol?
5. Do you get a bad reaction from MSG—monosodium glutamate—in food?
6. Do you have sensitivity to caffeine?
7. Have you ever been sick from exposure to chemicals?
8. Does cigarette smoke bother you or make you sick?
9. Are you sensitive to smog or air pollution?
10. Do you sometimes wake up in the morning feeling as if you’ve been drugged?
11. Ever have unexplained skin rashes?
12. Do you ever experience brain fog?
13. Do you feel a tingling in your hands or feet?
14. Is there consistent ringing in your ears?
15. Do you experience unexplained muscle pain?
Your responses to the questionnaire in Chapter 5 measure your personal sensitivity to environmental exposures and reveal possible symptoms of chronic toxicity. Whether from outside the body or within, accumulating toxins burden the body’s immune, nervous, and hormone-producing endocrine systems, so the symptoms of chronic toxicity are often seen as issues related to those systems. In addition, the more body fat, the greater the opportunity for storage of fat-soluble toxins; it means that body fat can contribute to chronic toxicity, which in turn connects to metabolic poisoning and increased risk of type 2 diabetes, cardiovascular disease, elevated blood pressure, kidney disease, neurodegenerative conditions like Parkinson’s and Alzheimer’s diseases, and certain forms of cancer.
If you scored high on this questionnaire, therefore, make it a priority to design a personalized health-management program that seeks to restore balance to your detoxification process. I wrote a book on the subject in 1999, The 20-Day Rejuvenation Diet Program, in which I described the results of a study of one hundred participants—with a range of chronic health complaints—who undertook a structured, twenty-day diet high in specific phytonutrients aimed at strengthening their detoxification process. In essence, this was a clean organic-foods diet comprising vegetable products—specifically, cruciferous vegetables, soluble fiber-rich legumes, and spices—and limited amounts of lean poultry and fatty fish. Eliminated were wheat products, caffeine, sugars, artificial sweeteners, chocolate, alcohol, synthetic colorings and flavorings, and preservatives. Monitored daily by our medical staff, the group experienced a greater than 40 percent decrease in such symptoms as low energy, sleep disturbances, fatigue, poor mental concentration, and chronic muscle pain.
In other words, dietary changes are a key path to restoring balance to your detoxification process. What are some key dietary supplements to support this process? They include the B-complex vitamins; the minerals iron, zinc, and magnesium; N-acetylcysteine; and phytonutrient concentrates from broccoli, brussels sprouts, green tea, pomegranate, watercress, turmeric, kudzu, red grape skins, and hops.
THE 20-DAY DIETARY DETOX
| Yes | No | |
| Organic vegetables | Wheat products | |
| Lean poultry | Caffeine | |
| Fatty fish | Sugars or artificial sweeteners | |
| B-complex vitamins | Chocolate | |
| Phytonutrient concentrates | Alcohol | |
| Synthetic colorings and flavorings | ||
| Preservatives |
Take an interactive version of this assessment online at q.hc.com/dd/4
DEFENSE
1. Do you tend to get every cold and flu that goes around?
2. Do you have sore joints that are made worse by modest exercise?
3. Ever get skin rashes of unknown origin?
4. Are you unusually sensitive to the sun?
5. Do your joints swell up?
6. Do you suffer chronic pain in your hands, wrists, ankles, or feet?
7. Is your grip getting weaker?
8. Are you losing muscle?
9. Do you have chronic sinus infections?
10. Are fungal infections—like athlete’s foot, for example—a common occurrence?
11. Do you have frequent bladder or urinary tract infections?
12. Do you have chronic intestinal pain or discomfort?
13. Do you have dental problems associated with periodontal disease?
14. Does it feel to you that your leg or back pain is chronic?
15. Do you take anti-inflammatory medications regularly?
16. Do you frequently take prescribed antibiotics to get over an infection?
17. Have you ever been diagnosed with any of the following?
a Epstein-Barr virus
b Herpes virus
c Candida albicans
d Lyme disease (Borrelia burgdorferi)
e A waterborne parasite like Entamoeba histolytica or Cryptosporidium parvum
f HIV
g Cytomegalovirus
h Clostridium
The Chapter 6 questionnaire about the defense process is aimed at learning how often and how much you experience infection and inflammation. Frequent or severe infections over time indicate too little activity in your cell-mediated and humoral immune systems. Frequent or severe inflammation indicates too much activity in the two functional units of that system.
The solution is not to “boost” your immune system, as so many nutritional supplements claim to do. Rather, you need to restore balance to your defense process. It’s a fallacy to suppose that the presence of an autoimmune disease means that you are allergic to yourself. There’s no such thing. Your immune process has evolved over millions of years to protect you from infectious organisms and foreign substances. An imbalance in the process makes you overreact to exposure to substances your body’s immune system sees as foreign or out of place; that’s what causes the inflammation. The way to redress the imbalance is to both reduce the exposure to foreign substances and provide the things that the immune system needs to send the correct messages to the genes that control inflammation.
How do we do that? By taking away the immune-reactive substances and adding back the immune-stabilizing substances. And how do we take away immune-reactive substances? First, we have to determine what they are. Some of the more obvious possibilities are gluten, pollutants, xenobiotic chemicals, and even overuse of alcohol. Chronic infections of the mouth—for example, periodontal disease—can trigger an imbalance in the defense system, and vice versa: an imbalance in the defense system can increase the risk of periodontal disease. People who regularly visit the dentist to have their teeth cleaned and who regularly practice impeccable oral hygiene at home but who nevertheless have periodontal disease probably have an underlying imbalance in their defense process. That’s the source of their infection. Also, if you’re of a certain age, it’s not impossible that mercury released from old mercury-amalgam tooth fillings may be burdening your defense process—something that has begun to show up a lot in members of the baby boom generation.
Immune-stabilizing foods and nutrients include mushrooms, vitamin C supplements of from 1 to 6 grams per day, and such botanical medicines as echinacea. In addition, some specific supplemental nutrients have been found to be of value in restoring balance to the defense process. Among these are zinc, vitamins E, A, and D, omega-3s, and a range of phytonutrients from spices—including curcumin from turmeric, allicin from garlic, and capsaicin from hot peppers.*
FOR AN IMBALANCE IN THE DEFENSE PROCESS: DON’T “BOOST” YOUR IMMUNE SYSTEM; RESTORE IT
1 Identify and remove immune-reactive substances.
2 Add immune-stabilizing foods.
3 Use these supplements.
a Zinc
b Vitamins E, A, D
c Omega-3s
d Spices
Take an interactive version of this assessment online at q.hc.com/dd/5
CELLULAR COMMUNICATIONS
1. Do you suffer from arthritis-like pain or inflammation?
2. Do you have night sweats?
3. Does a change in the weather produce joint pain?
4. Do your joints swell after physical activities?
5. Do you suffer from a feeling of low energy in the morning that takes until noon to overcome?
6. Do the stresses of your life affect your health?
7. Do you feel “wired and tired”?
8. Is your libido low for your age?
9. Are you chronically depressed?
10. Are you concerned that you’re more forgetful than you should be?
11. Is it difficult to get to sleep or stay asleep?
12. Do you have chronic infections of the sinuses, tonsils, intestines, skin, or mouth?
13. Do you routinely take anti-inflammatory medications, either over-the-counter or by prescription?
14. Are you on blood pressure medication?
15. Do you take antidepressants?
Five or more yes answers to the Chapter 7 questionnaire tell you that you have an imbalance in your cellular communications process and it is spreading alarm messages to cells, tissues, and organs around your body. All those thousands upon thousands of message substances are zooming every which way: the neurotransmitters that regulate nervous system functions, the cytokines that control inflammatory and immune system functions, the stress hormones that influence arousal and metabolic functions, sex steroid hormones that regulate reproductive and energy functions, adipokines from adipose tissue that regulate appetite and metabolic functions, hormones like insulin that regulate cellular energy function. An imbalance in the function of any one of these classes of cellular communication agents can alter physiological function in all the other processes—especially in the closely linked processes of assimilation-elimination, detoxification, and defense.
So if you scored high on the questionnaires for all three of those processes as well as for cellular communications, where should you start? In your assimilation-elimination process, the place where more than half your immune system is located and which can therefore trigger alteration in the cellular communication process. Begin with a plan to restore balance there. If there is no evidence of an imbalance in assimilation-elimination, your next priority is your detoxification process. Absent an imbalance there, then your primary focus should be on restoring balance to your cellular communications process first and foremost.
That means finding an approach that influences all the players within the cellular communications network. Menopause provides a good example, as a number of studies we pursued at the Functional Medicine Clinical Research Center made clear. Here’s why:
Hormones are of course some of the most important cellular communications substances in the body, powerful modulators of genetic expression. Their influence on communicating messages that affect all the core physiological processes is significant. In fact, they affect every aspect of our function from muscle strength and integrity to mood and mental function, from reproductive health to how we manage stressful events and how we look and feel. Our study focused on menopausal women experiencing significant adverse symptoms—night sweats, sleep disturbances, hot flushing, mood swings. What we found was that their symptoms were due not just to the fact that their ovaries were no longer releasing the estrogen hormones, but also to the way estrogen was being metabolized in their bodies and how it was being influenced by the imbalance in such other hormones as the stress hormone cortisol, the sex hormone progesterone, and insulin. In other words, it wasn’t just the cessation of ovarian activity that was causing the women’s symptoms; it was the imbalances in a number of related cellular communications substances—all networking together in their influence on health and vitality. What this told us was that, to alleviate the women’s discomforts, we needed to manage the imbalances within this system, not just focus on trying to improve the effects of estrogen.
The program we designed called for a diet plan with specified phytonutrient supplements, an exercise program, and relaxation-mindfulness training. The diet focused on lean protein from chicken and fish, the elimination of sugar-rich foods and beverages, increased fiber-rich vegetables and beans, soy-based products, increased intake of cruciferous vegetables known to improve the metabolism of estrogen, and a supplement containing an extract of Siberian rhubarb (Rheum rhaponticum) containing the phytonutrient rhaponosides, identified as a modulator of the estrogen cellular communication process. An extract of indole-3 carbinol (I3C) and its relative diindolylmethane (DIM), both found in cruciferous vegetables, helped improve estrogen-related symptoms, while black cohosh extract (Cimicifuga racemosa) and the soy phytonutrients genistein and daidzein helped manage estrogen-related cellular communication imbalances. The outcomes for the women in the study were highly positive.
The same story applies to cellular communications imbalances in men, and a similar dietary plan, using a different group of phytonutrient extracts, had an equally positive effect. The most common male symptom of cellular communications imbalance is benign prostatic hyperplasia, or BPH—an enlargement of the prostate gland deriving from an alteration in testosterone metabolism coupled with an increase in activity of inflammatory messenger substances. The phytonutrient beta-sitosterol proved effective in improving cellular communications in the prostate, as did the cruciferous vegetable phytochemicals I3C, DIM, and lycopene, the red phytonutrient pigment in tomatoes.
Does this suggest that there may be a place in medical treatment for selective bioidentical hormone replacement therapy? By “bioidentical,” I mean hormones that are identical to natural hormones at the molecular level—what Linus Pauling would have called “orthomolecular.” In my view, BHRT should be one of the tools available to be used in a personalized health-management program—but only when administered by a physician trained in the discipline. It should be remembered that hormones are very potent modulators of cellular function, and whereas a little replacement may be good, more can be dangerous.
Finally, it’s important to remember the role of allostatic load in designing a personalized intervention for cellular communications imbalance. It is why a primary objective of such an intervention should be a relaxation-mindfulness practice. In addition, some phytonutrient-rich botanical medicines can be of great help when increased allostatic load is an issue—among them, Siberian ginseng and Rhodiola rosea, or golden root, and Ashwagandha, or Indian ginseng; they have a long history of use as adaptogens working at the cellular level to normalize imbalanced cellular communications associated with the stress response. An adaptogen acts as a dual agonist-antagonist: When cellular communications activity is low, the adaptogen stimulates reaction; when activity is excessive, it antagonizes the activity and diminishes its function. It is thus a natural balancer of the process.
FOR AN IMBALANCE IN CELLULAR COMMUNICATIONS: DON’T SHOOT THE MESSENGER; IDENTIFY WHAT’S CREATING THE MESSAGE
1 Underlying inflammation?
2 Insulin resistance?
3 Poor fitness?
4 Toxicity?
5 Gastrointestinal imbalance?
Take an interactive version of this assessment online at q.hc.com/dd/6
CELLULAR TRANSPORT
1. Do you frequently experience brain fog and find it hard to focus?
2. Is your blood sugar count higher than it should be?
3. Do you frequently suffer from digestive problems if you eat high-protein foods?
4. Do you feel sleepy from time to time, especially after meals?
5. Have you gained weight—especially around the middle of your body?
6. Have your blood triglyceride levels gone up?
7. Do you have high blood pressure?
8. Have you noticed a loss of muscle over the last few years?
9. Is your LDL cholesterol higher than it should be?
10. Do you take a statin drug?
11. Have you been told that you have low albumin or hematocrit levels in your blood?
12. Has your doctor told you to cut back on the amount of cholesterol in your diet?
13. Have you been told that you have reduced kidney function?
14. Is your vision as sharp as it once was?
15. Do you have any concerns about the health of your heart and blood vessels?
The fifteen questions of the Chapter 8 questionnaire revolve around cellular transport of the critical nutrients protein, fat, and carbohydrate as well as of vitamins. If you answered yes to question 6, 9, 10, 12, or 15, you may have fat transport imbalances. If you answered yes to question 1, 2, 4, 5, or 13, you likely have a carbohydrate transport imbalance with specific issues in managing the transport of the carbohydrate glucose. If you answered yes to question 3, 7, 8, or 11, you potentially have protein transport imbalances.
An imbalance in the transport of protein can be related to either a dietary protein insufficiency or insufficient dietary intake of what is called quality protein. Protein in the diet is essential for health, of course, but the quality of the protein is also important, where “quality” refers to the makeup of the amino acids in the protein and whether the protein is digestible. Digestibility is important; after all, shoe leather is made up of protein, but trying to eat it to fulfill our protein needs would not be satisfactory.
As to amino acids, they are the building blocks of proteins. There are twenty amino acids in all, of which eight are called essential amino acids. “Essential” means that these eight cannot be made from anything else in the body; instead, they have to be ingested directly from our diet if we are to meet our needs to build the body’s proteins. These essential amino acids are transported through the bloodstream as part of the blood protein albumin. Low levels of albumin in the blood—or of hematocrit, another key marker of protein insufficiency—can therefore reflect imbalances in amino acid availability and transport.
A high-quality dietary protein provides a proper balance of essential amino acids. In general, animal proteins from meat or milk have higher levels of essential amino acids than do vegetable proteins. This is why vegetarian diets were once thought to be unable to provide adequate protein. But then along came Frances Moore Lappé with her classic 1971 book, Diet for a Small Planet, debunking this idea by showing that a combination of grains and legumes provides a balance of essential amino acids that is equivalent to that of proteins of animal origin. Lappé cited all those cultures that do just that—corn and beans in Central America, rice and soy across Asia.
If dietary protein is not properly digested and the amino acids don’t get absorbed, transported, and utilized in protein synthesis in the cells, then you will see signs of protein deficiency. On the other hand, a very high-protein diet can result in an overload of the transport process and result in kidney dysfunction. That’s why people with chronic kidney disease are often told to consume less protein; it takes the stress off a kidney that might be working too hard to transport excessive protein. In this as in all things in the body, not too much and not too little is what works: balance!
If your issue is a problem of transport of the blood sugar glucose—yes answers to question 1, 2, 4, or 14—then you want to modify your diet to include more protein, slightly lower carbohydrate content, and modest fat intake in the form of omega-3 and omega-9 oils from fish and virgin olive oil, respectively. This is of course the essence of the Mediterranean diet.
Defects in glucose transport and utilization show up first as insulin resistance—that is, the body’s inability to use the insulin it produces effectively, so that glucose builds up in the blood instead of being transported to the cells. That of course affects many core physiological processes and leads to metabolic syndrome from which follows a range of chronic illnesses from cardiovascular disease to arthritis to type 2 diabetes.* It is, in a way, the physiological imbalance of our age, and it is so critical that the staff of the Functional Medicine Clinical Research Center has long believed it warrants regular testing for such biomarkers as hemoglobin A1c, oral glucose tolerance, uric acid in the blood, high-sensitivity CRP (hs-CRP), and the ratio of blood triglycerides to HDL to catch it early.
For as we saw back in Chapter 1 in reviewing the work of Dr. Dean Ornish, changes in diet and lifestyle behaviors can literally correct cellular transport imbalances severe enough to cause even major blockage of the arteries to the heart.
A friend of mine, Joseph Piscatella, is living proof of that. I met Joe in 1983 shortly after he had published the Don’t Eat Your Heart Out Cookbook, written with the renowned heart surgeon Dr. Denton Cooley. Joe is arguably the longest living “recipient” of coronary bypass surgery. At the age of thirty-four—lean, fit, a nonsmoker, with a young family—he was diagnosed as being on the verge of a massive heart attack. At the time—the late 1970s—such a diagnosis would have doomed him to an early death. Instead, Joe became one of the first people to undergo a coronary bypass operation, after which he committed himself to a personalized program for restoring and maintaining his cellular transport process. It is to this that he credits what is now a long and healthy life—still going strong.
Dietary changes that may correct cellular transport imbalances include a lessening of carbohydrate intake to lower the amount of glucose in the blood—the body metabolizes carbohydrates into glucose—or, more specifically, eating the right kind of carbohydrate in the right amount. The right kind are unrefined starches—whole-grain bread, pastas, and cereals, for example—which release glucose slowly into the bloodstream. Avoiding carbs altogether can be problematic because the body functions most efficiently when proper amounts of glucose are available for transport, but reducing your intake of white starch and sugar and increasing your intake of whole grains and minimally processed vegetables and beans—all low-glycemic-index foods—will have little impact on blood glucose levels.
What about rice? With its high glycemic index, white rice is not good at managing blood sugar levels—that is, glucose. But the story is more complicated than that. After all, until recently, countries that were historically dependent on rice experienced minimal diabetes. One answer is that there are two varieties of rice, amylose and amylopectin. Amylose starch from long-grain rice is chemically more packed together in its architecture and therefore takes longer to break down in the intestinal tract; it’s a timed-release carb with less impact on blood glucose levels than the short-grain, amylopectin sticky rice. Historically, in these rice-eating societies, the eating of long-grain rice cooled the metabolic conversion of food to energy, while the eating of animal foods high in saturated fats heated it up—the yin and yang mirrored in eating as in all aspects of culture.
In addition to taking care with carbohydrates, a diet supporting cellular transport will focus on phytonutrients from such foods and spices as cinnamon, bitter melon, garlic, sage, oregano, hops, soy, salmon, nuts, avocado, oats, garbanzos, lentils, and kidney beans. Soluble fibers will also slow the release of glucose into the blood.
Equally effective for cellular transport is regular daily exercise. Study upon study confirms this. One at the George Washington School of Medicine found that a fifteen-minute walk on level ground at normal walking speed after each meal significantly lowered blood glucose levels in people with metabolic syndrome or prediabetes. This finding is in accord with the fascinating work of James A. Levine, professor of medicine at the Mayo Clinic and a world-renowned expert on obesity, who has demonstrated that the most effective way for people to implement a fitness program is by taking a twenty-minute walk after meals. Even what Dr. Levine calls NEAT—non-exercise activity thermogenesis, or fidgeting—can help lower blood sugar levels (and shed pounds) by supporting cellular transport.
Measured in time, the threshold for a significantly beneficial effect on glucose transport—as evidenced by improved biomarkers like hemoglobin A1c levels—is approximately 25 minutes a day or a total of 150 total minutes per week. It’s not too much time to spend to keep a balance in this core physiological process.
One important note: The connection between cellular transport imbalances and imbalances in the detoxification process is a close one. It has been our experience at the research center that if a low-glycemic-load diet plus an exercise program do not together correct an insulin resistance issue, the next step is to intervene in the detoxification processes. Our research shows that programs to restore detox balance also improve blood sugar, insulin, and triglyceride levels—a validation of the idea that persistent organic pollutants stored in fat tissues in the body can release toxic substances that poison the energy powerhouses of the cell, the mitochondria, and reduce insulin production and cellular action. The resulting defect in glucose transport can of course progress to insulin resistance, metabolic syndrome, type 2 diabetes, cardiovascular disease, and a host of other chronic illnesses.
One more thing: your answer to question 14, about vision, offers insight into the very complex transport process that nourishes the eyes. Central to the process is the macula of the eye, the only tissue in the body that purposely concentrates a pigment from the diet into the tissue. The pigment is lutein, and it is found in dark green leafy vegetables. A healthy macula contains enough concentrated lutein to color the tissue yellow. During an eye exam, your doctor will check out the color of the macula; a loss of color, representing either a deficiency in dietary intake of lutein or an imbalance in the transport of nutrients to the eye, could lead to damage to the retina. Age-related macular degeneration (AMD), more common than glaucoma, is the main cause of blindness in adults, affecting older adults in particular and often resulting in a loss of vision in the center of the visual field—the macula—because of the damage to the retina. It is increasing at an alarming rate. So a yes answer to this question may be an important early-warning signal to which you clearly want to pay attention.
ZEROING IN ON YOUR TRANSPORT IMBALANCE
| If You Answered Yes to . . . | Your Transport Imbalance Is Likely in . . . | |
| Questions 6, 9, 10, 12, 15 | Blood cholesterol and triglycerides | |
| Questions 1, 2, 4, 5, 13, 14 | Blood sugar glucose and insulin control | |
| Questions 3, 7, 8, 11 | Dietary protein intake, digestion, or utilization |
Take an interactive version of this assessment online at q.hc.com/dd/7
ENERGY
1. Do you routinely feel a fatigue you can’t explain or justify?
2. Are eight hours of sleep not enough for today?
3. Do you get muscle pain after even moderate exercise or activity?
4. Often feel brain fog?
5. Do you have trouble walking comfortably up a flight of stairs? Are you excessively winded when doing so?
6. Do you lack ambition or have low energy?
7. Ever find that you just can’t tolerate disturbances around you that you used to be able to ignore or dismiss or manage?
8. Do you worry about undertaking an activity that incorporates exercise because you know you won’t feel good afterward?
9. Are you often bone-weary?
10. Do you feel you just don’t have the energy to cope with the issues of daily living?
11. Do you frequently get headaches for no known reason?
12. Have your senses of smell and taste gotten worse?
13. Are you forgetting things you shouldn’t be forgetting?
14. Do you feel older than your age?
15. Does a regular old cold wipe you out for a prolonged period of time?
A breakdown in the function of the cellular energy powerhouses, the mitochondria, first affects those tissues with the highest level of mitochondrial activity—the brain, the muscles, and the heart. The questions you answered in Chapter 9 are designed to show if you have the memory issues, mood problems, exercise intolerance, chronic pain, or poor cardiovascular tone and function that may reflect an imbalance in your core energy process.
If so, a program of mitochondrial resuscitation can restore the balance. This requires going beyond the obvious question of maternally inherited mitochondrial DNA to factors within your control that can cause mitochondrial dysfunction. If you answered yes to the majority of questions 1, 2, 3, 4, 9, 10, 12, and 13, then there is a strong likelihood that you are suffering from an imbalance in energy processes; mitochondrial resuscitation can be a great help.
It means taking much larger quantities of substances that support mitochondrial function than would be found normally even in a well-balanced diet. Basically, these are levels of nutrients used for children with severe inborn mitochondrial DNA mutations, and they are orders of magnitude greater than the amounts recommended for a usual need.
HERE’S WHAT AN ADVANCED PROGRAM OF MITOCHONDRIAL RESUSCITATION MIGHT INCLUDE:
• CoQ10 50—200 mg
• N-acetylcysteine 500—3,000 mg
• N-acetyl carnitine 200—2,000 mg
• Lipoic acid 200—2,000 mg
• Niacin (B3) 50—1,000 mg (caution about flushing reaction at higher doses)
• Pyridoxine (B6) 10—50 mg
• Riboflavin (B2) 50—200 mg
• Thiamine (B1) 50—200 mg
• Folic acid 800—3,000 mcg
• Cobalamine (B12) 50—1,000 mcg
• Selenium 50—200 mcg
• Zinc 10—30 mg
• Ascorbic acid (vitamin C) 1,000—3,000 mg
• Mixed tocopherols (natural vitamin E) 100—800 IU
• Vitamin D3 1,000—5,000 IU
• Resveratrol (grapes) 50—200 mg
• Curcumin (turmeric) 50—200 mg
• Epigallocatechin gallate (green tea) 50—200 mg
Paul was the founder and president of a small business. It was a success, but Paul worried that he wasn’t as sharp as he used to be and that his competitors might be getting the better of him. It bothered him. He was bothered too by the fact that his tolerance for exercise had gone out the window. He could barely play nine holes of golf these days, even using a golf cart. He also ached all over; he swallowed ibuprofens like they were peanuts, but he still had sore muscles. Paul also had sleep apnea, so his physician had put him on a machine that forced him to wear a mask all night. Although this helped him get some sleep, he still didn’t feel good, and the machine was not exactly helpful to his marriage. He felt he was losing his edge in every sphere of his life.
Paul’s conditions were classic collective evidence of oxidative injury and mitochondrial dysfunction, deriving primarily from a diet consisting of too much of too little; he was simply undernourished in what was necessary for his proper bioenergetics. His personalized program was easy: to a Mediterranean diet was added a group of nutrient supplements geared to his mitochondrial resuscitation, primarily antioxidants and vitamins, which Paul took on a daily basis.* Improvement came quickly and kept growing. Within eight weeks, Paul was able to stop using the sleep machine; his apnea was gone. He awoke refreshed and felt that his brain was working well again. Although he had begun a modest daily walking program at the start of his program, he now embraced a serious fitness plan; he joined the local health club and took a class at least three times a week. By the following summer, he was back to doing what he had done as a young man—hiking the Rockies in Wyoming. He said he felt like a young man again too.
Paul’s eight-week response to his program of mitochondrial resuscitation was rapid; it’s safe to say it may take up to six months to feel the full benefits of such a program. But as implementation proceeds, you will typically begin to notice improved endurance, better sleep patterns, diminished fatigue, and greatly reduced muscle pain after exercise. Once full benefits have been reached and you feel you have completed the therapeutic phase of the program, it makes sense to transition to a maintenance program with lowered amounts of the supplemental nutritional support. The goal is to be able to sustain your endurance and mitochondrial function by maintaining a phytonutrient-rich food plan and a regular strength and conditioning exercise program. Also, once a person has undergone a successful detoxification program, it is much easier to sustain mitochondrial function with diet and exercise. You can then personalize the level of supplemental nutrients required to support your mitochondrial function by reducing your intake of the mitochondrial support nutrients and seeing how each reduction makes you feel.
In Paul’s case, as in so many cases, the detective work was a matter of looking at things in a new way and connecting the dots into a pattern of health and disease, rather than simply a list of symptoms. Even people who should be able to see the patterns don’t always, as was made very clear to me some years ago in Dallas, where I was giving a seminar for doctors. Following a three-hour session on mitochondrial bioenergetics and toxic substances, one of the docs cornered me; he was waving a file containing laboratory data. His laboratory data, as it turned out, because he was suffering the very symptoms of energy deficit I had just described. Yet as far as he could see, nothing in the data in his lab report pointed to mitochondrial function as the source of his troubles. “Take a look,” he offered.
What I saw was in fact the precise model of what I had been lecturing about: an elevated body mass index with insulin resistance, elevated inflammation markers, and elevated GGTP enzyme level in his blood. Remember GGTP? It produces glutathione in the body, possibly in order to detoxify a buildup of chemicals causing mitochondrial imbalance. But this doctor, trained to look at data from an “old medicine” perspective, simply could not apply a new paradigm of understanding to his own information; he just couldn’t see it any other way.
I went through it with him, and he soon got it. And once he had it, he ran with it, putting together his own personalized program combining detoxification and mitochondrial resuscitation measures. The first step toward change is often to see the picture in a fresh light.
Take an interactive version of this assessment online at q.hc.com/dd/8
STRUCTURE
1. Do you feel you’re getting shorter over time?
2. Have any back problems?
3. Do you frequently get a sore neck?
4. Are you a frequent cell phone user?
5. Have you been told that you have elevated hemoglobin A1c?
6. Do charbroiled foods show up frequently in your diet?
7. Any memory problems?
8. Do you have a weight problem even though you watch your calories like a hawk?
9. Is your waist-to-hip ratio greater than 1?
10. Do you eat a lot of foods and drinks stored in plastic containers?
11. Are you one of those people who are “cold all the time”?
12. Have you been told you have reduced bone mass?
13. Are you menopausal?
14. Do you pretty much avoid dairy products?
15. Do you eat proportionally way more animal protein than vegetables?
For an extreme example of the relationship between structure and function, I can think of nothing more searing than the shocking evidence I once saw of what happened over time to a group of drug abusers. The evidence was in the form of photographs of eight individuals—four men, four women—in their late twenties and early thirties, all of them arrested for selling and using drugs.
The initial pictures showed eight normal, attractive people. The next batch was taken a few years later, after a subsequent arrest for continued drug use. The difference was overwhelming. Although only a few years had passed, all eight individuals looked decades older. Their faces were so distorted it was hard to recognize that they were the same people as in the initial photographs. It made me wonder what their organs, tissues, cells, and subcellular structures looked like. I knew that they too would have aged unrecognizably, and that the deterioration in structure would be reflected in deteriorated health and function.
So-called recreational drugs illustrate how exposure to foreign substances can produce profound imbalances in our core physiological processes, effecting change in the overall structure and function of the individual. It’s an extreme example; the genes of the people in the photographs had spoken so loudly and with such hostility to these foreign invaders that they completely distorted their genetic expression, causing these radical changes in all aspects of the addicts’ structure and function.
Structural imbalances can also occur much more subtly and not as severely through injuries, poor posture, or lack of proper muscle- strengthening activities or flexibility. The effects on physiological function may not be as profound as those seen in the group of drug abusers, but nevertheless influence the other core physiological processes.
If many of your answers to the Chapter 10 questionnaire indicate an imbalance in your core structural process, your health and function are also at risk. Today, the most prevalent structural imbalance is central obesity. Unfortunately, most weight-loss remedies are ineffective. If they succeed at all, it is only temporarily before the dieter swings back to an even higher weight. The reason is that these weight-loss diets focus too heavily on managing calorie intake and not enough on controlling the type of information in the message a specific calorie delivers to the genes. Calories perceived by the body to be foreign or hostile turn on the genes that store food as fat; this angry fat produces adipokines that trigger inflammation, which can lead to chronic illness.
Our research center has published study after study—as have many other researchers—demonstrating how a food plan comprising foods that send friendly messages to the genes produces proper appetite control and results in a new, healthy set-point weight and leaner body composition, one that is minus the angry fat that is the biggest risk for disease. Moreover, studies have shown how and why severely obese patients, most on various medications for various ailments, who undergo gastric bypass bariatric surgery are typically able to eliminate their meds within days of the surgery. Well before they lose any substantial weight, the rerouting of their digestive tract has begun to send different messages to their genes, calming their angry fat. Again, the structure of the body connects directly with its function through genetic expression. Yes, you can do it with surgery, but that is a lot riskier—a lot costlier in so many ways—than doing it through changes in lifestyle, diet, and environment.
In short, the priority in the design of a personalized program to restore structural balance is to harness the genes themselves to do the work of reshaping the body’s structure and function—simply by sending them the right information from our diet, lifestyle, and environment. Such a plan will combine an eating plan that sends the right messages to the genes—resulting in the loss of angry fat and the activation of mitochondrial energetics in the muscle—with an exercise program for long-term control of energy processing.
If your imbalance is structural at the whole-body level—that is, if you answered yes to question 1, 2, 3, or 12, your whole-body structure has been compromised, and physical medicine may be the answer. Osteopathy, chiropractic, therapeutic massage, or acupuncture can be an important first step in improving health. Be aware that structural imbalances resulting from sports injury or trauma probably require rehabilitation, not physical medicine.
Be aware also that adequate amounts of calcium and vitamin D are important for your skeletal health; if you undertake weight-bearing exercises as part of your personalized program for restoring structural balance, these should be taken as supplements. But take them only if you engage in weight-bearing exercise. Astronauts at zero gravity for extended periods of time lose bone despite ingesting calcium and vitamin D supplements. It requires resistance, like gravity, for exercise movement to incite our genes to express the necessary proteins to capture calcium and build bone. Without the resistance, the specific genes for bone formation remain at rest, and bone loss results.
FOR AN IMBALANCE IN STRUCTURE, ADDRESS BOTH THE PHYSIOLOGICAL AND THE PHYSICAL
| For weight loss (physiological): | A food plan that sends friendly messages to the genes in order to control appetite and create a new set point for a healthy body weight. | |
| For whole-body issues (physical): | Physical medicine and/or exercise, with calcium and vitamin D supplements when you are doing weight-bearing exercise. |