After of a decade learning from some of the best minds in Naturopathic & Functional Medicine (FM), the way I summarise our health is a complex relationship between our genetics and the decisions we make – nature & nurture working together. Our health can be influenced by what our mother ate while we were in utero, and by what we ate last night. Rarely is it determined by a single gene or single event but instead by the cumulative effects of thousands upon thousands of decisions we make every day, and how our genes & cells respond to those decisions. Knowing how our body interprets those decisions and turns them into health or disease helps us leverage the power of our own choices. In other words, our health is not determined by the cards we are dealt, so to speak, but the way we play the hand.
A experienced Functional Medicine Practitioner (FMP) is someone that has the skills & expertise to comprehensively & functionally assess an individual suffering with poor health to enable them to make contextually relevant & meaningful clinical decisions based on the unique body of evidence-based data in order for them to have the best chance in improving the patients outcome from a functional wellness perspective.
In Functional Medicine (FM) practice; one key area of my work is what I refer to as ‘Lifestyle Medicine’ (LM) and the evidence-based scientific landscape that is associated with it which I want to delve deeper into first to set the scene.
So we know that a combination of poor lifestyle choices over time can seriously effect, or negatively influence the health of an individual person and a population; but like anything in FM, it’s always important question this, and ask ourselves, why? What causes good or bad lifestyle decisions to effect health or disease, and what are the driving mechanisms or underlying causes that are behind the rapid increase of metabolic diseases like obesity & diabetes? And just how does our body take in the informational signals it receives from food, physical activity, stress, and sleep and turn this into changes we later call disease or health?
By us understanding the answers to the questions above, we would have the key of knowledge to the mystery and power of lifestyle medicine, that can unlock the gate leading to prevention and reversal of most chronic diseases plaguing the worlds population.
I personally have a very logical, pragmatic mind that likes to reverse-engineer problems in order to come up with the answers which lead to me to the solutions, however, everyone is different so I’ll expand on things as much as I can so people can fill in their own blanks themselves.
New scientific discoveries are happening every single day. Just think about where we are today with science & technology, compared to where we were a decade ago. It’s like night & day. Although some things that we have learned from the past will continue to be, and are unlikely to change; such as some of the core principles of biology & physiology; much of what was thought to be scientifically proven or confirmed 50 years ago, or even 10 years ago, has been disproven, debunked, or diluted today with new more up-to-date evidence that has expanded or explored the subject in question even deeper using the latest scientific technology and more accurate study designs that weren’t available to us then.
I believe a good FMP (or any good clinician for that fact), should stay up-to-date with the latest research studies, or scientific breakthroughs, and evolve and adapt their skills, views & beliefs where necessary as science evolves. A good practitioner’s clinical decisions should always be based on & backed up by the scientific literature (not just an idea, concept, or view) to ensure safety, efficacy, and deliver evidence-based outcomes that have been clinically proven by science (not opinion) to improve patients health.
Ironically, many of today’s physicians, clinicians & practitioners who actually went through medical school did it a long time ago, and a lot continue to be stuck in the past on old science, old concepts of that time, or archaic ways of thinking. Churning out mid to poor level results working with patients, if they are lucky. Until we expand our horizons and think more laterally, we will never move the needle of the dial that leans more towards disease than towards health in today’s modern world.
I want to start off with a very old and basic observation which is: the human body has an amazing ability to heal itself. You don’t need to know much about the intricacies of the immune system or molecular biology to appreciate this reality. This notion of self-healing is rooted in a much larger phenomenon. To put simply, “life” is imprinted at every level of our being, while death is an intruder. Life, by its very essence, is self-sustaining. “Life” speaks more than merely a physical existence, but something much deeper – something superimposed upon our biology. The term the “will to live”, often seems to trump physiology. But how does this concept of “life” translate into physiological events that actually preserve us, and keep us healthy?
There were one or two subjects or topics at school I really disliked. Latin was one of them! The reason for the dislike was I couldn’t see how it would benefit or enhance my later life. It was only until I started studying natural medicine a decade ago that I learned to appreciate Latin, as so many medical terms were written or formed from the ancient scripture. One Latin phrase I’ll always remember is ‘vis medicatrix naturae’ which is a term to describe a phenomenon often used by natural healing traditions that translates to the “healing mechanism” that is intrinsic property of our body. What this “healing mechanism” is and how it works are obviously explained or interpreted in different ways, depending on the tradition, most of which having done so, well before the benefit of modern scientific research.
After decades of evidence-based research, from epidemiology to epigenetics, we can still say, without any doubt, that the intrinsic healing potential resident within our body is by far the most powerful medical tool we possess. It is a tool we often let languish as we look past what the body can do by itself and toward what what are perceived as more powerful drugs and surgical procedures to supposedly “fix the cause of disease”.
It has been said that “the art of medicine consists of amusing the patient while nature cures the disease”. And why we don’t mean to trivialise the vast knowledge and skill set of today’s FM clinician, sometimes the job of a masterful clinician is to provide only the necessary elements or interventions that allow the patients body to heal itself which for some people is less, and for others – a lot more. It always make me cringe when I hear some people call themselves ‘healers’. It’s such a god-like statement like they have some special powers. I’ve no time for these kinds of people. The only thing that truly heals the body is the body itself. The clinician is just the middleman.
So powerful is the bodies healing mechanism that the clinical trials are not considered valid unless they are “controlled” by giving what’s known as a ‘placebo’ to one group (unbeknownst to them) in order to subtract this influence, which is often so strong it prevents the tested therapy from reaching clinical significance. Among other things, the placebo response has taught us that many of the improvements seen after clinical intervention can be attributed wholly, or partially to this intrinsic healing property of the body.
If we combine the power of vismedicatrix naturae, our bodies own healing potential, with understanding from the latest research defining the mechanisms of chronic disease, we can absolutely revolutionise the current paradigm of medicine and unleash the power of lifestyle medicine as it was intended.
What mechanisms allow our body to convert the thousands upon thousands of input signals into healthy (or unhealthy) outcomes? What are the most powerful health promoting signals? Does everyone have the same natural healing capacity? Will the same inputs be good for everyone? How much abuse can the system tolerate before it stops working? And can you improve your natural healing capacity?
Our bodies are designed to take the appropriate messages from our “lifestyle “and turn them into “health”. Since the most powerful remedy is the intrinsic healing mechanism within our bodies, therapies always work best when they are targeted towards triggering these mechanisms rather than circumventing them.
Fundamental to the process of sustaining life in the face of a potential mortal threat or perceived threat is prioritising those functions that are vital for immediate survival over those that are not. Under stressful situations, such as something like having to quickly jump out of the way of vehicle travelling at high speed; maintaining optimal long-term bone mineral density is of little immediate concern. Proper bone turnover perform by osteoblasts and osteoclasts metabolism is not likely to save your life in this particular case. Fast forward to a few decades and the repeating neglect of bone mineralisation can make you vulnerable to a life-threatening fracture. This illustration teaches us an important lesson: our bodies use a sort of “triage” or assessment method to decide what functions are of immediate life-saving importance, suspending other important functions which are not needed to solve the immediate crisis.
If chronic long-term functions remain neglected for too long or undergo frequent suspension, chronic dysfunction will be allowed by chronic disease. The lifestyle synergy model in relation to long-term health is a delicate balance between solving immediate needs and at the same time maintaining enough resources for healthy future.
I just want to quickly revisit a classic concept that I’ve written and talked about many times in the past, for anyone who’s unfamiliar, and that’s the term ‘homeostasis’ which is used to describe the body’s own healing capacity. This is the idea that the body has a “steady-state “, or a set point, and a series of mechanisms to maintain this set point. Homoeostasis is something viewed like a thermostat that turns on either the heating or the cooling system to maintain a fixed temperature. We are told, for instance, that “normal “body temperature is 37°C, and deviations from normal often signal problem. Actually, “normal “body temperature is not a fixednumber but follows a subtle curve throughout the day and even throughout the month (especially in premenopausal women). In fact, body temperature is rarely ever “normal “, being constantly adjusted by the time of day, hormone levels, metabolic needs, room temperature, and physical activity. The complexities of the processes that maintain body temperature known as Thermo regulation I just one part of the many into related, fluctuating systems within our body. Ironically, they are actually very few truly “steady-state “in biological systems. Most things tend to be dynamic. In fact, body temperature is rarely ever “normal “, being constantly adjusted by the time of day, hormone levels, metabolic needs, room temperature, and physical activity. The complexities of the processes that maintain body temperature known as Thermo regulation I just one part of the many into related, fluctuating systems within our body. Ironically, they are actually very few truly “steady-state “in biological systems. Most things tend to be dynamic.
The Greek term “homoeostasis “was first applied to these biological functions in the days when we only had crude measuring tools unable to detect subtle changes in many bodily functions. As with body temperature, however, subtle fluctuation and sometimes wide ranging oscillating patterns are actually the norm for most biological systems. Frequently these fluctuations track along a circadian rhythm, which I’ll go on to talk about in a been aw The Greek term “homoeostasis “was first applied to these biological functions in the days when we only had crude measuring tools unable to detect subtle changes in many bodily functions. As with body temperature, however, subtle fluctuation and sometimes wide ranging oscillating patterns are actually the norm for most biological systems. Frequently these fluctuations track along a circadian rhythm, while others follow certain specific events such as eating or stress; for some the controlling mechanisms are still unknown. For instance, in a normal, healthy person the stress hormone cortisol might be 10 times higher when they are awake and then it is while they’re asleep at 2 am. We really think of this sort of variation when we think of homoeostasis, but, in fact, this is normal. Perhaps another term should be used to describe this phenomenon on, one that encompasses it’s rhythmic, dynamic, and reactive characteristics.
It’s important to first recognise that the key to maintaining our health lies with our bodies capacity to maintain the rhythmic and reactive nature of these dynamic homoeostatic mechanisms, whilst at the same time maintaining the integrity of these mechanisms dependent upon receiving interpreting host the physiological signals. Some of those signals come from within our bodies, while the rest come from the outside world. The majority of the signals that train and maintain these mechanisms, not surprisingly, are those we provide through diet, physical activity, sunlight, sleep, and a host of other lifestyle related activities. The good or bad signal means that we either provide help or hurt our ability to stay healthy and therefore increase or inhibit the benefit we get when using other interventions like supplementation, diet & nutrient therapy, surgery, and even pharmaceutical drugs when & where necessary.
Lifestyle medicine is not about doing the same exact thing every day but about understanding the rhythms and responses that our body uses to keep us healthy. When our actions mirror this understanding, we create a synergistic force that unlocks the healing power within each cell. We must work with the body, not just aim to impose a solution upon it. The FM work I do is about applying the necessary force where required to create enough physiological change to restore function, whilst at the same time trying to mimic & align the interventions as close to normal physiology – working with the forces of the body – which in my experience yields the best long term results.
If the ability to maintain health is a design feature built into our bodies, why don’t we just remain healthy all the time? This might seem obvious when we think of major external threats such as extreme injury or trauma such as car accidents, gunshot/knife wounds etc, invading organisms such as systemic infections, viruses & bacteria, or major genetic defects that result in a compromised and defective metabolic machinery; but aside from these major types of events, what accounts for the drift from health to disease that seems to be inseparable from normal ageing and is creeping into the experience of younger and younger individuals as we pass each decade? To answer this, i need to explain the evidence-based concept that is called ‘physiological resiliency’ or the ‘buffering system’ as I like to refer to it that every single organ system relies upon to compensate when things go wrong… and believe me, things can, do & will definitely go wrong.
Physiological resiliency is built into nearly every level of complexity in our bodies, from the enzymes designed to scan DNA for damage before cell divides, to the process that allows sleep to reset the stress response system. Simply put, our bodies have an amazing capacity to buffer unfavourable events and recover when things go awry. These overlapping systems, each with their own regulatory mechanisms are constantly adjusting and readjusting based on thousands of input signals that come from inside and outside our bodies. Like a rubber-band or coiled spring; both these mechanisms have a given resiliency or threshold that creates a “bend but don’t break “system. But just like a rubber band, overstretching the system time and time again is not without its consequences. SNAP!
To unpack this concept further, let’s start with the basics of how buffering systems work. We often think of buffering systems in chemistry when we are attempting to maintain a steady concentration of a particular ion. One of the most important chemical buffering systems in the body helps control the pH of our blood. Keeping the appropriate acid-base balance in the blood is crucial for immediate survival as we simply cannot function very well when our blood strays from the optimum pH of 7.4. This highly regulated pH is needed to maintain the appropriate environment for metabolic reactions in the bloodstream and tissues. Since the blood pH is so critical, this buffering system has a very narrow range & must be tightly regulated to keep us alive. In this case, we have a carbonic-acid bicarbonate buffering system that involves both kidney and lung function. When we are physically active and our muscles require more oxygen and energy, they produce hydrogen ions and carbon dioxide. When these compounds diffuse into the circulation, the carbonic-acid/bar carbonate buffering capacity of the blood compensates for these changes and the lungs and kidneys help to reset the buffering capacity of the blood.
Many events can trigger the need for blood pH buffering systems, including the basic metabolic functions of all cells, changes in temperature, certain foods, certain supplements, stress signals of all kinds, infections, and certain pharmaceuticals. It is critical that these factors do not alter the pH of the blood, hence the need for the buffering system. If the buffering system is unprepared for sharp alterations in blood pH, a major health emergency quickly ensues as there is little room for error. On the other hand, some tissues in the body function better at PH ranges that they have from the blood – some slightly more alkaline, some slightly more acidic, and some greatly more acidic (like stomach which has a pH of between 1 to 3).
Each cell maintains its own buffering capacity that is, in turn, enhanced by the bloods buffering system. Blood pH is a true acid-base buffering system, but a number of other biological systems also adopt the general definition of a ‘buffer’ that I have just talked about. Another important system we could describe as an overlapping buffering system is the highly coordinated antioxidant system the body uses to prevent oxidative damage to our tissues. Normal cellular activities produce billions of highly reactive intermediate chemical species called ‘free radicals’. These free radical compounds are important and necessary for the function of the cell, but they are highly reactive and must be tightly controlled to preserve the integrity of cell structure & function. A complex network of antioxidants is designed to prevent these reactive intermediates from damaging cells and tissues. Some of these antioxidants are enzymes such as superoxide dismutase (SOD), some activity oxidants are produced in the cell by enzymes such as glutathione (GSH), some we must ingest such as vitamins C and E, and some actually induce the production of enzymes that then produce antioxidants such as sulforaphane that’s present in broccoli.
In a few cases, like the powerful nutraceutical antioxidant compound lipoid acid (ALA) which I frequently use in FM practice for various applications; agents can act directly as antioxidants, indirectly by recharging other antioxidants (in this case of vitamin E, vitamin C, and glutathione), and by inducing antioxidant enzyme systems. Since the burden of unquenched, unpaired free radicals forms a basis for one of the leading & most robust scientific theories behind the cause of ageing and chronic disease progression, the strength of our antioxidant network is critical to our overall health and ageing process.
Decisions we make about diet, physical activities, environmental exposure, and how we manage our stress load complete a tremendous role in depleting or expanding the anti-oxidant buffering capacity and, in turn, the physiological resilience of the systems that maintain our health.
Now I would like to extend the term “buffer” to more complex systems to give you a better understanding of the mechanisms that produce the physiological resilience we rely upon…
Unlike blood pH, which is maintained within a fairly tight window (closer to the original definition of homoeostasis), blood glucose levels are more dynamic, and must necessarily rise and fall in response to food consumption and metabolic needs. In fact, the rise in blood glucose triggers an increase in the production of insulin that is critical for glucose transport into many cells. So in this case, we need to have a responsive system that allows for a transient increase in blood glucose with a compensatory rising insulin to drive this important energy source throughout the body and into the cells needing glucose for metabolic activity. Maintaining appropriate blood glucose levels throughout the day is a highly coordinated effort involving numerous organ systems, hormones, cell signalling mechanisms and intra-cellular metabolic processes. Unstable blood-sugar as an example has many indirect negative consequences on many other body systems & metabolic functions.
The current obesity epidemic represents the cumulative stretching of the buffering capacity of an entire body. In a very fundamental way adipose tissue, or stored body fat is specifically designed to help buffer the ebb and flow of nutrient availability. When feast is followed by famine, this buffer is a means of survival as it bridges the difference/deficit in energy substrate availability by releasing stored lipids into the bloodstream that yield 9 calories per gram. When feast is followed by more feasting, however, then our buffer system sometimes doesn’t know how to turn itself off. So when blood sugar rises, adipose tissue in the form of fat cells is capable of removing the immediate danger to sensitive tissues by converting glucose into fat and storing it for the future. When stress induces high levels of the hormone cortisol; adipose tissue is also activated to store more fat. When fat soluble toxins which are lipophilic (fat-loving) accumulate in the body, they also build up in adipose tissue, some toxins even stimulate fat production. In fact, adipose tissue can be stimulated by any number of signals to increase the storage of fat. A higher toxic load often results in a higher degree of oxidative stress. The fat storage mechanism is in many ways the bodies ultimate buffering system as such as its capacity of the fat storage and human seems to be without limit but not without consequence.
Since the body is designed to treat stored fat as a buffer future needs, it has mechanisms to protect the accumulated adipose tissue from being used up. When someone loses substantial amounts of fat by dieting, it can actually trigger the brain to think playing crisis, often promoting and increased desire to eat and a metabolic shift with heightened fat production. This is a normal part of how the body attempts to preserve its buffering system by causing hormonal & chemical shifts under the conditions. Our buffers have a limit: if we’ve been in too far, they will break and not permit us to go where we need to go as a protective mechanism, or in worse cases, the system has sustained physiological damage.
The physiological resilience we have outlined here could be described for hundreds of different biological processes in our bodies. Earlier I talked about blood pH, blood sugar, adipose cumulation, and the antioxidant system; but nearly every important biological function has a complex buffer type system intended to keep the organism within a window of viability and function. Some of the systems are tightly controlled; others have quite a bit more flexibility. Unfortunately, each of these buffering systems has a limit.
As researchers studying chronic diseases have discovered, there are common pathways that drive these dysfunctions – independent of the type of solo tissue. Among these come on pathways, and the most frequently cited are inflammation and oxidation. These two pathways play a major role in many metabolic-related diseases including diabetes, cardiovascular disease, Alzheimer’s disease, chronic kidney disease, arthritis, prostate disease, IBD, and many forms of cancer.
While these two factors are responsible for depleting the metabolic reserve a critical tissues; irony is that without inflammation or oxidation, we wouldn’t survive at all which presents a conundrum. Unlike the acute diseases that mainly come from outside of our bodies, chronic disease is almost always a result of processes wearing away on metabolic reserve and buffering capacity, even though these processes are designed to prevent them from becoming harmful. In most cases, it is the dysfunctions from within that allow the external threats to wreak they have it, like the cold virus taking advantage in a mean system depleted a vital nutrients, or an infection to enter the body due to immune barrier weakness. These external threats may have been re-buffed and even gone unnoticed had it nor been for the lack of metabolic reserve in the systems. The decisions we make that affect our metabolic reserve, whether good or bad, I helping to determine what area we will be at our weakest link.
To be fair, it’s important include two other factors that can predispose and influence our risk of disease. The first would be the genes we inherited from a parent; the second would be those environmental factors we cannot control. While these two factors are not insignificant, researchers still believe 80-90% is preventable by proper lifestyle choices alone, in fact, lifestyle interventions can often change a genetic predisposition (something known as epigenetic‘s, or trump genetic predisposition if you will by altering gene expression. This alone is a very strong scientific argument to back up the power of lifestyle medicine.
Although the lifestyle/buffering model I’ve just written about at length applies to everyone; each persons version is highly individual. Theres a saying: “you are only as strong as your weakest link”. The vast majority of the patients that I’ve worked over the years have had a number of weak links that are collectively contributing towards their poor state of health. Some obvious, and some not so obvious that had to be hunted down, and teased out. Prior to coming to work with me, a number of these individuals had either been diagnosed with, or were being treated for conditions with drugs that were a indirect result of other underlying issues. Suffering in silence, and not getting well. This is why working with a natural health professional who has the skills & expertise to uncover the functional weak links & connect the less obvious dots using evidence-based science & technology as a guide, combined with their skills & intuition is key in the functional wellness restoration process.
Since addressing my own health issues that I painfully endured for many years; over a decade ago; which profoundly led me to study FM professionally; my passion for constantly evolving my craft & in helping others has allowed me make a difference to the lives of others by helping many people restore their health and functional wellness over the years. If you are someone who has either been failed by the system, or has suffered in silence for way too long, and are looking for someone who has the skills and personal experience to help change that then feel free to book a free 30 minute informal consultation to discuss your case & see if we can help.
Thank you for your attention.
*By Steve Hawes