Maybe I’m bias because of my professional background, but Functional/Lifestyle Medicine (FM) is by far the most effective method of wellness restoration that aligns with normal physiological function, how nature intended. I describe FM as Naturopathic Medicine on steroids. It still has some of the core principles of Naturopathic philosophy in that everything centres around the gut, as ‘she’ feeds every other organ system in the body – but is way more rounded, and has an evidence-based scientific edge in that it looks beyond the gut. It comprehensively assesses hormones, neurotransmitters, metabolism, biochemistry, lifestyle, as all these are all hardwired into, and effect our biological circuitry of functional wellness.
A skilled & experienced FM practitioner is
always precise, thorough, and targeted in their approach, whilst at the same time being open-
minded, and adaptable when and where necessary. Even during times when there may be a specific clinically justified requirement to go from physiological dosing to more aggressively targeted therapeutic dosing using standardised botanicals, bioidenticals, or nutraceuticals – a good FM practitioner always has in the back of their mind to mimic physiological function as close to how nature would have intended.
A good FM practitioner will continue to dig deep to uncover the underlying mechanisms that are either driving, or reinforcing the patients health issues, and not chase after symptoms, as symptoms are only an outward expression or manifestation of internal conflict or dysfunction being fed by certain signals.
In this weeks article I want to talk about a major mechanism behind illness & disease which i refer to as the body’s internal inferno…. “inflammation”…
Inflammation, whether acute or chronic – like many other diseases is what I refer to as a ‘lifestyle disease’ in that the majority of instances it is completely preventable. The term ‘lifestyle disease’ refers to any chronic disease that could have been prevented or avoided by changes in one’s lifestyle such as diet and exercise habits, stress, sleep and environmental factors. Some examples of this include conditions such as Type II diabetes, obesity, cardiovascular diseases such as atherosclerosis, hypertension, some liver and renal disease and many cancers. Even for those that have a genetic predisposition such as a SNP, which on paper – may have an increased potential risk to developing certain illnesses, diseases, or health condition, there’s no doubt that our lifestyles, the choices we make, and our environments dictate, or influence the expression of whether the predisposition is a actually problem or not.
Simply put, inflammation is the immune systems response to a stimulus that is viewed as foreign (unrecognised) a threat, or toxic to your body (also known as an antigen).
The immune system is on constant surveillance, on the look out for anything that appears as a foreign intruder (like infectious bacteria or other harmful material) that shouldn’t be in the body, and is always at the ready to signal it’s highly specialised troops of cells and molecules to attack and dispose of the foreign material.
Inflammation, when functionally modulated, can play a positive role in our health as a primary defence mechanism against acute conditions, like when a fever fights off an infection, or when blood & fluid rushes to a sprained ankle to help heal the tissue. Those examples are both inflammatory responses. In essence, the mechanism of inflammation is an essential part of the healing process, it’s when it goes bad and the immune system is disrupted, or dysfunctional, that it puts the body in an unnecessary constant state of high alert or defence, flooding the body with inflammatory cytokines which are chemical messengers that systemically circulate throughout the body – adding more gasoline to the blaze. In this state, instead of serving you, the system is actually working against you by switching it’s focus from the antigen it’s supposed to attack, to instead launching a targeted strike on your own cells, tissues and other harmless material.
Acute stress, like acute inflammation, is not necessarily a bad thing. We actually need this inbuilt instinct as it initiates the “fight or flight“ mechanism, alerting us of potential danger, or driving us to meet a deadline. It is when the stress goes into overload, and becomes chronic, that it becomes a toxic signal, flooding the body with a cascade of catabolic stress chemicals. All stress signals trigger & engage the bodies inflammatory response, whether that be a beneficial stress such as having a good workout in the gym, to suffering a bereavement or loss of a family member. The mechanism is the same but just to different degrees.
Stress signals begin, or register in the brain, specifically the hypothalamus. In response to a real or perceived stressor, certain hormones are released and sent down to the pituitary gland which then goes on to trigger the adrenal glands to respond/react. The adrenal glands sitting on top of each kidney may only be small but they pack some of the most powerful hormones and neurotransmitters the body has that are involved in energy metabolism and in the stress response. The glands themselves are chiefly responsible for releasing adrenal steroids, such as cortisol and the catecholamines (the fight or flight hormones – epinephrine/adrenaline/norepinephrine) from different locations of the gland. In response to a stressor, first to the scene is the release of adrenaline. This gets your heart pounding, pumping blood to the extremities. Following this is the release of cortisol, the “get shit done“ hormone which dampens the surge of adrenaline to provide the body with strength and stamina by releasing stored energy & amino acids from the liver & muscle tissue. This survival response is only meant to be short lived as it’s a catabolic response meaning the body is breaking down its own tissues to survive. It is when there are excessive signals coming at the body from all angles, triggering this inflammatory response that physiological resiliency declines, and metabolic reserve is depleted. It’s here that physiological damage occurs, body systems are weakened, and symptoms manifest.
In times of chronic, prolonged stress; cortisol and adrenaline are permanently cranked up too high or are elevated way too frequently which cannot be sustained long-term. At a certain point, due to the destructive nature of this mechanism when chronic, the body down-regulates the inflammatory response by suppressing cortisol production as a protective mechanism to prevent its demise. It doesn’t just end there either… When the host system is overloaded, it effects many other body systems including its immune defences. When the systems go down, become dysfunctional or imbalanced, it can lead to a whole host of undesirable symptoms such as mood issues, digestive complications, food cravings or sensitivities, low sex drive, sleep issues, energy issues, blood sugar dysregulation, autoimmune conditions to name just a few.
I’m sure you may have heard of the term ‘adrenal fatigue’ thrown around before; however, the correct term is HPA axis dysregulation, as the glands themselves are neither fatigued or exhausted. It’s the system that’s reduced their output as a protective mechanism. The stress signals have overloaded the negative feedback loop that has then signalled the body’s “engine limiter” to put it into “limp mode” like a car engine with a fault, to reduce its output & performance and prevent it sustaining further damage. Keep in mind that whether it be stress from physical illness, or a food sensitivity – all stressors follow a similar physiological path to destruction and alters gene expression making the body even more inflammatory.
In general, at times, life can be exhausting. And anyone suffering from chronic, inflammatory conditions is likely to be all too familiar with fatigue. While assessing & eliminating sources of inflammation is important; it’s essential to not overlook the basic practice of getting enough rest. Even short-term sleep deprivation can cause inflammation and contribute towards chronic disease. Lack of sleep effects hormones and brain function causing you to crave high sugar and junk foods which ultimately lead to an increasing inflammatory insulin production. Sleep is the body’s master reset switch for stress and modulating the inflammatory response.
The amount of people that rely on a daily fix of stimulants such as caffeine from the moment they open their eyeballs in the morning to jumpstart their burned-out energy systems, giving them short-lived, artificial surge of energy to get them through the day is extremely high. While there are some studies showing benefits of coffee in small amounts, mainly down to the fact that it has mild antioxidant properties – from a nutritional standpoint, it’s far wiser getting antioxidants from eating fruits and vegetables. While coffee in moderation may be fine for some people who are in a relatively good state of health; anyone who is inflamed, under chronic stress, or suffering with fatigue; coffee can definitely do more harm than good.
When you consume coffee it triggers the release of stress hormones (catecholamines) which cause the body to release adrenaline which result in blood sugar spikes. This leads to corresponding spikes of insulin which then increases inflammation. The net result is feeling even more drained because you’re taxing your adrenal gland reserve ,which for most is pretty depleted already. This can lead to a weakening in energy regulation & the stress response mechanism.
Below I’ve listed some common conditions associated with chronic inflammation, some of which I see in clinical practice daily:
- Alzheimer’s disease
- Autoimmune diseases of all kinds
- Cardiovascular disease
- Diabetes (Type II)
- Fibromyalgia and CFS
- Inflammatory bowel disease (IBD) also including crohns disease, and ulcerative colitis
So what are some of the causes that lead to the destruction of our immune system and result in chronic inflammation that can manifest in any of the above…?
Well, when it comes to actual causes of the internal inflammatory inferno, It could be one particular signal that is driving the cascade of dysfunction, or a number of signals, (small fires) that can come together in the combination to create a chronic inflammatory condition that results in an inferno that sweeps through the body like wildfire.
Maybe you have any existing autoimmune or other chronic disease… maybe a food allergy or intolerance you aren’t aware of… maybe an array of pathogenic infections, microbial imbalances or a fungal overgrowth that is dominating the internal landscape… maybe you are in a bad relationship, or a stressful job you despise that is like riding a mental & emotional rollercoaster on a daily basis, ringing every little drip of energy out of you like a wet cloth…. maybe your sleep is terrible, you don’t exercise enough, or are doing too much… maybe your are experiencing chronic pain from an old injury… maybe you’ve exhausted your physiological resiliency and depleted your metabolic reserve, and weakened one of a number of your core body systems such as the neuroendocrine system, the gastrointestinal system, the immune-system, or detoxification mechanisms resulting in physiological damage…
Whatever it may be, all the above, and more are ALL inflammatory signals which feed into a perpetual cycle that in-turn, keeps adding more fuel to the fire to keep it burning stronger, and longer, whilst slowly wiping out the body’s internal functional community.
Now, what’s interesting about inflammation is it doesn’t necessarily need to be coming from just one source, or an obvious location, and it can manifest in many different ways. For example, someone could be experiencing joint pain, or cognitive impairment and have no gut symptoms, yet the source of the joint pain or the brain fog may be from inflammatory cytokines that originally came from the gut. Now all of a sudden you have an inflamed brain and/or joint tissue that’s being generated from a completely different location. That’s just one example.
Chronic inflammation has the potential to ignite your whole body on fire, very much like a real fire would, and like-for-like be just as destructive, and in some cases, downright deadly. It is critical that we understand what ignites the fire in our lives and take action to put out the flames.
The digestive system is the foundation for wellness and immunity, seeing as it has the highest concentration of immune cells in our entire body. Somewhere between 80-90% of our immune system resides in the digestive tract. In addition, the small intestine is where 80-90% of nutrient absorption occurs.
The gut has four quite critical functions:
- To digest food and convert into vitamins
- Absorbing nutrients
- To prevent toxins and pathogens from entering the bloodstream
- To activate thyroid hormones, that are involved in almost every physiological processes in the body
- To assist and facilitate in the excretion of toxins (Phase 3)
A big determent to ensure the above processes work effectively and efficiently is the make up of the bacteria or micro organisms that live within the digestive tract, otherwise known as the gut microbiome.
The microbiome is loosely defined as the community of microorganisms or microbes (beneficial and harmful) that share a body space – not only in our gut, but on our skin, in our mouth, nose, throat, lungs, and urinary tract.
The bacteria in our bodies our numbers our human cells at an estimated ratio of 10 trillion to 1 which demonstrates their importance, and how crucial it is that we have a strong, working relationship with the friendly bugs within us.
Through our diet we provide the nutrient substrates to feed these beneficial bacteria, which in turn creates a diversity in species, and keeps them communicating with one another, producing vitamins and beneficial bi-products that help regulate our metabolism, our immune system, assist in gene expression, our digestion and many other processes that contribute to functional wellness.
Unfortunately, the digestive system and the related processes it in charge of can be compromised in many ways which result in inflammation, which can effect the microbiome with the main two being:
- Dysbiosis – In a healthy gut, the good, or beneficial flora outweigh the bad. The good guys act as a physical barrier to the bad. If the good guys get killed off, don’t show up in the first place, or if you consume a diet the feed your body more bad bacteria, it makes more room for the pathogenic variety to take over. This leads the way to a skewed ratio of much more bad bugs vs good bugs a.k.a. Dysbiosis
- Leaky Gut – The protective mucosal lining of your digestive system regulates the passage of nutrient particle into your bloodstream. This can be damaged or physiologically weakened by various dietary, infectious and environmental factors. This causes the digestive system to become overly permeable. In other words the intestinal cells or tight junctions become wider than they should, thus allowing antigens and larger protein molecules to enter the bloodstream causing an chronic immune over-activation. When this protective barrier breaks down, it takes whole system with it – over-engaging, overburdening and weakening the other body systems.
Usually your intestinal wall is woven like a piece of cheese cloth, however, when it’s “leaky “though, it’s more like a tennis net. This series of openings are much larger which means undigested nutrient particles get into your bloodstream before they’ve had time to marinate in the proper digestive juices, which means toxins and bacteria can also pass through. These escapees are viewed as foreigners by your immune system and can trigger an antibody reaction leading to inflammation, putting a huge strain on your entire metabolic system. Over time, if untreated, this can lead to autoimmunity.
For years the very un-clinically sounding term ‘leaky gut’ was only truly acknowledged in more alternative settings, and not by conventional medicine. However based on the scientific literature, and evidence supporting intestinal hyper permeability being highly associated with inflammation, autoimmune disease, cancer and other chronic conditions, it’s been becoming more widely accepted by individuals that initially felt it was quackery. Who can blame them really as the name does sounds made up – however, intestinal hyper-permeability is a very real physiological dysfunction not to be ignored.
There is a very strong interrelationship between how our cells function, how are genes are expressed, our environment, our microbiome, inflammation and chronic disease.
As humans we are made up of trillions of cells which are the building blocks of each and everyone of us living organisms. What keeps ourselves functioning appropriately (i.e. preventing disease) is providing them with proper nutrients and avoiding insults from toxins in our environment. Our cells also contain our individual genetic make up, or DNA.
Just like a fingerprint we are all individually made up of unique sets of genes and characteristics. What makes each of us more distinctive is that our diet, lifestyle, and environment can combine to determine whether our genes manifest into good health or poor. To some degree, we are able to choose to create a body that is either disease resistant or prone to inflammation.
For some people, genes & SNP’s seem all the rage. In fact, they literally live and die by their polymorphisms. It’s all they talk about. Over the years, and even to this day, I’ve come across many people who because of a gene SNP or two, have been living their lives paralysed by fear, like they are walking around carrying a nuclear bomb that could go off at any minute. Most of these individuals aren’t in great health themselves. The reality is that their obsession is another signal that’s reinforcing their condition.
It was only the other day that someone posted a question on my social media group regarding some health issues they were facing involving endocrine tumours or growths, as well as other health challenges. I highlighted the fact that there MAY possibly be a genetic component to this (something that even if you know you have, you can’t change) and that my sole focus would be on assessing the functional & lifestyle components (things you can change & influence) that effect the expression of a certain genetic predisposition.
Sometimes people are so disease-focused, or myopically fixed on one thing such a gene (that often they cannot change) that they completely overlook the opportunities that surround them (things they can influence) which can potentially change their outcome.
“Focus on what you can change, and not what you can’t” that’s my motto.
What a lot of people aren’t aware of is that for the vast majority of chronic diseases, your genes only make up 10-20% of your risk. What makes up the other 80-90% is the signals that active their active behaviour. Your environment, what you are putting in, on and around your body, as well as the lifestyle that you lead. I know where I’d put my money if I were I betting man.
“Genes may load the gun, but it’s environment and lifestyle that pulls the trigger”
I often use easy to understand analogies with my patients, to help understand what is going on them. This puts their mind at rest, and stops them overthinking. One analogy is use is to picture our health like an undeveloped film/photo, and the process in which it’s turned into a photograph. Every aspect could influence what the end result is – the developing chemicals, processes, the type of camera, and the photographer themself. Each factor has the ability to enhance, or sabotage one another. It’s the decisions we make, our lifestyle choices, and our environments that determine the integrity of what makes it in our bodies, what’s kept out, how effectively what does gain entry in is handled, metabolised, absorbed or excreted that determines how well our picture of health develops.
Thanks for your attention
*By Steve Hawes