At the beginning of this book, I promised you a revolution in health care comparable in its impact to that of the bacteriological revolution at the beginning of the last century. That prior revolution led to the conquest—or at least the control—of infectious diseases. This one will empower us to get a handle on the chronic illnesses that are burdening our increasing longevity.
In the first revolution, the main players were the physicians, clinical researchers, and pharmaceutical companies devising medication after medication to zap our infections and palliate our symptoms. In this revolution, the main players are us. The breakthroughs in our understanding of how lifestyle, diet, and the environment influence genetic expression and determine how we look, act, and feel make each one of us part of the transformation in health care. It’s up to us to work with our health-care professionals to develop our own personalized health-management program. As I wrote early on, we have both the opportunity and the power to realize our optimum genetic potential.
The transformation cannot happen soon enough. Globally, the rise in the prevalence of chronic illness, striking people of all ages, both genders, and all races, is exponential. It is reminiscent of, if not equivalent to, the infectious disease epidemics of earlier centuries. But if we are confronting a de facto plague of chronic illness, we have the knowledge and technologies to both prevent and manage the progressively harmful health conditions the plague brings us.
It starts with our new understanding of how the human genome is read and with the application of a systems biology view of the body as a network of interaction among seven core physiological processes. We see that the expression of each individual’s unique set of genes can be edited by environmental factors and by the individual’s nutritional habits and lifestyle behaviors. Those revisions to the book of life may cause imbalances in one or more of our core physiological processes, starting us on the path to illness. In Shakespeare’s words, the fault “is not in our stars, but in ourselves”—not rigidly fixed in our genes, but capable of being re-edited and re-revised by our subsequent actions and shifts in behavior. This both gives the lie to genetic determinism and makes it clear that if we change environment, diet, and lifestyle in certain ways, we can restore balance to our core processes and thereby affect our personal pattern of health and disease.
THE REVOLUTION IS HAPPENING
We see it happening all over—in clinical research and in on-the-ground evidence about one chronic illness after another. Again, not a moment too soon: the World Health Organization 2011 Summit on the global economic burden of noncommunicable diseases estimated that the cost of chronic disease would hit $47 trillion by 2030—due mostly to heart disease, metabolic diseases like type 2 diabetes, chronic respiratory diseases like asthma, chronic kidney disease, cancer, and dementia.
This last, dementia, may be the most costly of all—both in dollars and in its impact on the sufferers of dementia and their families. In the United States as of 2012, dementia has been costing more than either cancer or heart disease—more than $200 billion in 2012 alone. We have as yet found no effective drugs for the management of dementia, but a variety of clinical studies indicate that lifestyle changes can improve mental functioning. At the famous Karolinska Institutet in Sweden, a study found that changes in diet and exercise improved cognitive function and reduced dementia. A study at the Mayo Clinic concluded that early intervention with lifestyle medicine could delay the onset of dementia, although it was not sufficient to treat later stages of Alzheimer’s dementia. But numerous studies have indicated that a Mediterranean diet can lower the incidence of both Alzheimer’s and non-Alzheimer’s dementia.
Similarly compelling evidence supports personalized lifestyle changes in addressing insulin resistance and type 2 diabetes—specifically with health-management programs to improve glucose transport and insulin signaling. Because insulin resistance disturbs sleep and collaterally damages so many tissues, potentially damaging the eyes, kidneys, nerves, heart and arteries, and brain, such programs can have a major impact on health.
Where cardiovascular disease is an issue, personalized programs of health management, particularly through diet, have shown clear and profound benefits as they signal the genes to reduce inflammation and improve fat transport. A 2013 study in the New England Journal of Medicine calculates the significant impact of a Mediterranean diet rich in virgin olive oil and nuts in reducing the incidence of major cardiovascular events—including heart attack. Some of my own research, including that performed in collaboration with Deanna M. Minich and published in Nutrition Reviews in 2008, shows the value of certain phytonutrients serving as selective kinase response modulators (SKRMs) to influence genetic expression and lower the risk of cardiovascular disease. Multiple research studies confirm the point: phytonutrients in a well-designed diet plan do indeed speak to our genes.
Stress is another key driver of core imbalances leading to a range of chronic illnesses—as well as a contributor to infectious disease—and the research continues to show how a personalized health-management program can reduce the allostatic load associated with excess stress. Allostatic load can come both from psychological distress and from exposure to xenobiotic substances. Whatever the origin of the allostatic load, the research is clear that restoring balance to detoxification processes can reduce the burden on our defense systems and thereby lessen the chance of inflammatory responses causing autoimmune diseases.
Much research has also focused on the role of healthy gut microflora in sending healthy messages to our genes—and the impact on our genes if the microflora are adversely affected by a poor-quality diet. We know that high-fat, high-sugar foods increase the risk of metabolic endotoxemia—that is, the release of toxic substances from the intestinal tract into the blood, adding to the total load of alarm message our genes pick up from the environment, compounding “bad” communication with the fat cells and making them angry, augmenting the risk of disease. A personalized diet program can restore balance to the enteric microflora and change the signals our genes receive.
I offer this not to repeat what has been said in the previous chapters but as a reminder that the functional medicine revolution—anchored in the idea of personalized health management—is now accessible to all. From head to heart to gut to toe, from cognitive impairment to stress to that spare tire around the middle, scientists are showing how individuals can change the course of events that lead to chronic disease. That means you.
YOUR MOVE
The good news is that just at a time when we need a new, fresh approach to managing the growing burden of chronic disease, the solution has emerged. It derives from the genetic uniqueness we each have and the recognition that there is no such thing as a one-size-fits-all therapy.
The human genome evolved over several million years, shaped by numerous environmental factors. Your particular human genome is distinguished by unique skills and capabilities written into your book of life. The question is: How will you adjust your lifestyle, diet, and environment to realize the potential of that uniqueness?
You now have the tools to create a personalized health-management program to help you do just that. Building on the baseline program presented in Chapter 12, you can follow the guidelines set forth in Chapter 13 and begin to design your own plan.
The resources for helping you do so continue to multiply, and many key websites—a font of information—are listed in Appendix C. They will tell you how to find a functional medicine practitioner, learn more about ongoing research, get answers to your personal questions, connect with other health-conscious consumers, locate a lab for your own genetic testing, and more.
My aim in this book has been nothing less than to create a global population that is better informed about today’s health-care revolution—one reader at a time, starting with you. I hope it leads you to make some changes in the interest of your own good health today and in the future, and I know that’s not easy. Changing customary behaviors and ingrained habits never is, even when it’s as worthwhile as it can be for you.
And there’s no book of rules telling you how to do it or enforcing compliance. Guidelines and suggestions on how to personalize your program are just that, and they are only as valuable as the commitment to apply them. In other words, you need to own your own program and find your own way to apply the guidelines in your own life. The good news is that the more committed you are, the more positive your health outcomes will be, and the better your health outcomes, the greater the reinforcement of your commitment.
You don’t need much in the way of accessories. You might want a tape measure so you can track your waist-to-hip ratio—less than 1 is the goal. A portable machine to measure blood pressure might be a good idea as well. And a pedometer, whether on your belt or on your smartphone, is a definite recommendation as you measure your daily quota of 10,000 steps. Moreover, as you’ll see in Appendix C, there is a burgeoning industry in mobile apps for tracking health and fitness, and these can certainly be useful in keeping you aware of the intimate relationship between your actions and your genetic expression. You can also go to our website at www.plminstitute.org, where you’ll find more information and answers to most of your questions.
The promise of future technologies is very exciting indeed, but equally exciting in my mind is how the new ideas born of the genomic era are reframing old observations and are prompting a melding of the best knowledge and practical experience from many perspectives—East and West, traditional and futuristic, the laboratory and the village.
Most exciting of all, I think, are the broader social implications of the functional medicine revolution. Darwin published On the Origin of Species in 1859, and his description of evolution and natural was a game-changer for the way people have looked at life ever since. Simplified—often to the point of a simplistic slogan, “survival of the fittest”—Darwin’s analysis of evolution got boiled down to the notion that some people are just born more fit than others. Those people had won the gamble of genetic roulette, and everyone else was out of luck—stuck with an inferior genetic profile. Most tragically, this social Darwinism, as it was called, eventually became a catchall justification for some of the most tainted ideologies of all time—the pseudoscience of eugenics, racism, imperialism, and Nazism.
Now, however, thanks to the genomic revolution, social Darwinism must give way to the new biology of genetic expression and epigenetics—and therefore to a new model of genetic plasticity. Biological bigotry—the idea that some are born more fit and therefore more worthy—is dead and buried. Long live the new reality of genetic uniqueness and taking charge of your own pattern of health. Now we have scientific certainty that differentiating function on the basis of “genetic fitness” is as phony and as empty as differentiating function on the basis of race or gender. All are simply unacceptable. There are no superior genes. There are only superior diet, lifestyle, and environment, and we all have an equal genetic opportunity to create them for ourselves.