Monday, October 25, 2010


Physicians who practice Complementary Alternative Medicine talk of and write endlessly about oxidative metabolism. Our present approach is, however, largely shot-gun in character. That is a reflection of our collective ignorance, but the question arises as to whether the application of non-caloric nutrients (vitamins and minerals)is an appropriate methodology in the treatment of virtually any disease, the model on which a great part of Complementary Alternative Medicine (CAM) is founded. Is it truly a paradigm shift in overall concept? We certainly know that it usually, if not always, works. We have a huge amount of information about vitamins and minerals, but still do not know how to balance them. In spite of the general impression that modern medicine is a scientific bonanza I see myself standing on the “beach of knowledge, looking at the ocean of ignorance”

The Three Circles of Health
Over the years I have provided my patients with a model that introduces them to the concept of oxidative metabolism in a very simple way and this essay is to try to describe it. Imagine three interlocking circles derived from Boolean Algebra. They seek to describe the influence of variables by the degree of overlap between them. Label them "Genetics", "Stress" and "Fuel (nutrition). The genetics circle, for most of us an unknown factor, always enters the equation. With a strong Mendelian genetic defect it may be the unavoidable factor, but the discovery of epigenetics tells us that even this can be modified for benefit since it is the study of how nutrients and lifestyle influence our genes. Cystic fibrosis, an example of a genetically determined disease, can be helped by nutritional implementation. That represents the overlap between the genetics and fuel circles.
Stress, poorly defined for medical purposes, is defined here as a “mental” or “physical” force imposed by living in an essentially hostile environment. It includes all the variables of mental and physical forces to which we have to adapt as we encounter them daily throughout life. Unless the force, whatever that may be, is overwhelming as in any lethal mechanism imposed, it is not the stress that is the problem. It is how we adapt or maladapt to it that is the problem. The fuel circle is our nutrition.
Imagine that you have bought a car. You do not know it, but somewhere in the structure of that car there is a weakness, perhaps a flaw in the engine. As it ages it is being “stressed”, particularly by the hills that it has to climb. One day it breaks down on a hill and when you receive the bill for repairs you are told that the breakdown occurred at the site of the structural weakness. Do you blame the hill or the structural defect, about which you were ignorant? Obviously you can blame neither. The hill was a part of the journey undertaken. But suppose that you never bothered to read the owner’s manual and you have been putting in a fuel that is not consistent with the engine design. If and when the breakdown occurs, it is only the fuel that can be blamed since it created less efficiency in the function of the engine, imposing a greater liability for breakdown. The body has exactly the same problems in principle. This becomes an easily understood concept of how stress is converted into disease, the equivalent of breakdown.
The next part of the model depends on understanding that efficiency in a fuel-burning machine, including the 70 to 100 trillion cells that make up the human body, is defined as the useful work produced by the machine in proportion to its fuel consumption. A car is said to be about 35% efficient, meaning that 65% of the energy produced from burning gasoline is wasted in friction and noise. The body is estimated to be 75% efficient, a very different story.

Oxidative efficiency
Lack of oxygen (anoxia), already discussed, is lethal but it is not usually known by many as being lethal in excess. Every diver knows this. Efficient body metabolism is midway between too little oxidation and too much, the Yin and the Yang. Oxygen consumption will be less at rest and will increase in proportion to the mental or physical exertions of the individual. Health can be seen as maintaining efficiency throughout all levels of activity. Oxidants, the vitamins that enable oxidation to occur, are the equivalent of spark plugs in a car. Antioxidants are the equivalent of the cylinders since they represent the “firewall” that enables the energy to be controlled.
Imagine that a camper wishes to light a fire in a clearing in a forest. He risks setting the forest on fire so he constructs a fireplace. But as the fire becomes more flagrant it begins to throw off sparks that also endanger the forest. The camper can place a wire grill over the fire in order to catch the sparks and thus protect the forest. The body has the same problems to solve. Every cell has to create its energy by literally burning fuel. This oxidation is carefully controlled in “fireplaces” in the cell, known as mitochondria. When we are at rest we use less oxygen and when we exercise physically or mentally we use more, as long as we maintain efficiency. A wire screen over a fire is an important analogy because it is only effective because of the multiple wires. None of them can catch the sparks on their own.
Mother Nature knew that these “sparks”, known as free oxygen species, would form under any form of stress imposed by physical and mental activity and took steps to put together a series of chemicals that all work together like the wire screen in the analogy. It is therefore important to understand that antioxidants only work as a team and any one of them alone does not provide metabolic safety. Nor can we ask whether, for example, vitamin C is “good for any particular disease” in the same way that we might ask whether aspirin is good for headaches. The nutrient scenario is completely different from that of the pharmaceutical treatment method.

We can now imagine that the oxidants form one half of an imaginary roof and the antioxidants the other half. They must balance just like an architect would design a roof. The whole roof or part of it might fall in or the roof could sway one way or the other. Like all analogies, this is an incomplete representation, but it does provide a basis for understanding the problems facing us in what might be called “repairing the roof”. Good nutrition is the ONLY way that the "roof" can be repaired. This is exactly what Linus Pauling said in 1971 when his article in Science proposed that health was maintained by the presence of each and every necessary molecule being present in the body. This became known as Orthomolecular Medicine and a medical journal is published under that concept.

From a purely functional, rather than an anatomical concept, think of the human brain as being in two parts, the upper part being the “cognitive” or conscious part that does the thinking whereas the lower part,called by Freud the subconscious, limbic system is clearly a very complex computer that continuously senses the state of our personal environment. It is responsible for all our survival mechanisms that include the fight-or-flight reflex, and vital components of species survival such as appetite, thirst and basic sex drive. I think of the body as like an orchestra where the organs are like banks of instruments and the cells within them are the various instrumentalists. The limbic system is the “conductor”. The conduct of our daily lives depends on the conductor’s ability to play the “symphony of health”. The two parts of the brain “talk” to each other to modify our behavior. The computer “talks” to the various organs in the body through a balanced activity of the sympathetic and parasympathetic branches of the autonomic nervous system. This system is involuntary and is automated by the limbic system. The computer also controls the glands that make up the endocrine system by a closed biofeedback mechanism. Hormones are really messengers of the conductor’s ability to communicate with the organs. The organs even “talk” to each other.
The last part of this model depends on the tissues in the body that are most dependent on oxygen. Brain is well known to be number one in this requirement, particularly the part known as the limbic system and the brainstem, since they function all the time throughout life. The heart also works full time and is perhaps next on the list. It possibly explains why the ancient scourge of beriberi is a disease of the heart, brain and nervous system. The excess calories cannot be “burned” (oxidized) efficiently. Many of us can remember that we had a mechanism in cars called a choke. If that mechanism stuck after starting the car from cold, the engine would splutter and the car would hesitate. Black smoke from the exhaust represented unburned hydrocarbons. That is what happens to many people in our modern world who insist on the pleasure derived from eating masses of sweets and simple carbohydrates. They are never able to understand that their many symptoms, usually written off by physicians as psychosomatic, are due to their “junk”. Like white rice, “junk” is defined as a substance that we eat that contains no “spark plugs”. This gives rise to the term “empty calories”. Notice that I used the word “substance” rather than “food”.
The extremely common result of all this is a condition that I have called Functional Dysautonomia. Although published in medical journals, it is not a term that you will find in a medical textbook. It is, however, perhaps the commonest condition in Western civilization since the diet of the masses is frequently appalling . I refer to it as High Calorie Malnutrition and the early stages of the decline that results produces symptoms that area usually dignosed as “psychosomatic”. In a crazy world, two thirds of the human population are dying from the results of increasing starvation, while one third are suffering disease and decay from overeating the wrong foods.

Thursday, October 14, 2010

What has oxidation to do with disease?

We have discussed the use of oxygen and how it is used to create energy by the process of oxidation. Now I am going to tell you how oxidation reflects health and disease. Many people are aware of the classical nutritional deficiency diseases known as beriberi (thiamine, B1), pellagra (niacin, B3) and scurvy (vitamin C). Each one represents one or more aspects of inefficient oxidation.
The best example for illustration is beriberi. This disease has existed for thousands of years and it was not until the early years of the 20th century that it was found to be due to deficiency of vitamin B1. Thiamine is an essential factor in the oxidation of glucose, a major fuel for the brain and nervous system. All simple sugars that include lactose (milk sugar), sucrose, fructose (fruit sugar) and even starch are broken down in body metabolism to glucose.
The commonest cause of beriberi for centuries has been the consumption of white rice and why it was so common in Eastern cultures. It has recently been reported in Japan in a group of adolescents consuming sodas and simple carbohydrate food substances. White rice is the grain from which the cusp has been removed by milling. Outbreaks of the disease occurred throughout history and were related to increased affluence when the peasants were able to afford the luxury of having their rice crop milled. They did this because it looked better when served to their friends and demonstrated their newfound affluence. Thiamine occurs naturally in the cusp around the grain and the miller would throw the rice polishings to the pigs that were therefore better fed than the humans. The grain, with the cusp removed, is just starch and the disease is therefore represented as a load of glucose with an insufficiency of thiamine to oxidize it in the synthesis of cellular energy. Epidemics also occurred in the summer months when workers in the factories would take their lunch outside. When the sun shone on them, some would develop their first symptoms of the disease so it was natural to believe for a long time that the disease was caused by an infection. An adult human body consists of between 70 and 100 trillion cells, all of which require thiamine, the equivalent of a spark plug in a car engine.
The tissues that have the highest metabolic rate, correlating with their consumption of oxygen, are the heart, the brain and the nervous system, so beriberi has its primary effect on those organs. If the affected cells are starved of either oxygen or the major catalyst that enables glucose to be oxidized, their energy is curtailed and their function becomes abnormal or ceases. In the next blog I will tell you more about how this process affects our health in the modern world.
It has long been thought that these classical nutritional deficiency diseases have been conquered in developed countries because of vitamin enrichment. Unfortunately, that is simply not true. They do exist but not in their classic presentation and I have seen them all, often unrecognized even in a major hospital setting. Most modern physicians do not even consider the possibility of a nutritional deficiency as a cause of disease and rarely do they recognize the way that they appear. The diagnosis is nearly always missed.