Healthcare has been a hotbed of activity in our nation’s capital for years. While everyone acknowledges the escalating costs of medical treatment, the debate always seem to center on the economics and allocation of healthcare services. Our elected representatives avoid the more pressing question: Why are Americans so sick?

Dr. Jeffrey Bland of the Personalized Lifestyle Medicine Institute takes aim at the matter in The Disease Delusion: Conquering the Causes of Chronic Illness for a Healthier, Longer, Happier Life. Chronic illness gives rise to runaway healthcare costs and blunts human vitality. Unfortunately, the prevailing medical protocols treat symptoms with invasive procedures and prescription drugs rather than get to the root cause of the problem. As such, patient conditions progress, and the prescription drugs they take may produce adverse collateral effects.

According to Dr. Bland, chronic illness is the result of an imbalance in one or more of the following core physiological processes:

Assimilation and Elimination: Most of us are aware of the fact that what we eat determines nutrient availability for our bodies. We need a healthy gut to extract vital nutrients while creating a barrier against toxic substances that might otherwise leak into our bloodstream. What we may not realize is that the gut also produces and secrets messenger substances that impact a multitude of physiological functions. When any part of this complex system is thrown off kilter by a poor diet or food allergens, chronic disease may result. Solution: Identify/remove food sensitivities, bolster digestive enzymes, and ingest proper nutrients through diet and supplements.

Detoxification: Our livers take responsibility for processing toxins and preparing them for safe elimination. These toxins can be introduced from the outside or take the form of a metabolic byproduct from normal cellular function. Problems arise when the total load of toxins outpaces the liver’s processing capacity. Solution: Minimize environmental toxins and support detoxification with pro-detox foods (e.g., green tea, turmeric, cruciferous vegetables, watercress, cranberry, pomegranate, red grapes.)

Defense: Our immune system takes responsibility for identifying pathogens and eliminating them from our bodies. To perform effectively, it monitors what we eat and what we experience in the environment and stands ready to go on the offensive. A genetic predisposition combined with one or more “triggers” and a leaky gut may cause an autoimmune response – i.e., an attack on the body’s own tissues. Solution: Identify/eliminate triggers and repair leaky gut through diet and lifestyle changes.

Cellular Communication: Cellular messaging manages interdependencies among core physiological processes. Chronic inflammation alters cellular communication, causing imbalances in the hormones that circulate in the bloodstream. It can manifest as chronic sleep problems, mood swings, fatigue, inability to concentrate, and anxiety. Solution: Identify and eliminate sources of inflammation in the environment, diet, and lifestyle. Consume foods rich in flavonoids and polyphenols to prevent inflammation (e.g., nuts, berries, garlic, onion, grapes, citrus, green tea).

Cellular Transport: The nutrients we ingest must find a way to nurture all of the cells in the body. Protein (as amino acids and albumin) and carbohydrate (as glucose) can be carried by the bloodstream directly. Low Density Lipoproteins (LDLs) transport fat and fat-soluble vitamins (A, D, E, and K) to the cell wall; High Density Lipoprotein (HDL) retrieves the LDL and returns it to the liver. All of these elements need to be in balance for the body to function properly. Solution: Eat a balanced diet based primarily on whole (not processed) foods. Engage in regular aerobic exercise to raise HDL and lower LDL.

Energy: The mitochondria in our cells transform the end products of digestion into energy. Too many calories over too long a period cause mitochondrial burnout. Excess stress for prolonged periods and aging also diminish our production capacity. Solution: Limit caloric consumption using a predominantly plant-based diet. Engage in aerobic and anaerobic exercise regularly to stimulate mitochondrial production.

Structure: We need proper alignment of our bones, muscles, and nerves to function at peak efficiency. Imperfect alignment gives rise to excess wear-and-tear and pain. We also need a proper amount of body fat. Abdominal fat increases the risk of type 2 diabetes, heart disease, stroke, dementia, kidney disease, and breast and prostate cancer. Solution: Bone health requires good nutrition, weight bearing exercise, good digestion, no (or minimal) inflammation, and proper insulin functioning. FYI – Dr. Bland is a fan of the Mediterranean Diet.

When treated by a functional medicine practitioner, doctor and patient form a partnership to ferret out the root cause of disease and develop a personalized solution based on changes in environment, diet, and lifestyle. This process may entail some trial-and-error to determine what suits the individual’s unique physiology. The physician must be attuned to the patient’s feedback; the patient knows best about his or her condition and the impact of certain therapies and interventions. The partnership works when the parties share knowledge and divide authority. While the treating physician can provide expert guidance, the patient must take responsibility for making the requisite changes to improve health outcomes.

I suppose that my interest in healthy eating would inevitably lead me to understand a bit more about my digestive system. After all, it’s responsible for processing the food I eat, extracting the nutrients to feed my body, and eliminating a lot of waste. So, to help the system do its job, it matters what I eat and how I eat it. But I never appreciated the complexity of the whole process until I read Dr. Michael Gershon’s book, The Second Brain.

It turns out that we have a distinct neural apparatus that runs our digestive operation. Dubbed the enteric nervous system, it contains over 100 million nerve cells to manage the precise chemical reactions necessary to get what we need from food while simultaneously defending the body from harmful substances. By giving our guts their own intelligence, our brains are free to address a myriad of others inputs, signals, decisions, and actions without worrying much about digestion.

Our brains play a role at the start of digestive process as we experience food through our senses (especially taste and smell), or even think about it. It causes us to excrete saliva that will moisten the food as we grind it with our teeth. It also signals the stomach to ramp up production of digestive juices. While we’re chewing, the enteric nervous system receives signals to indicate what’s coming down the line so the stomach can make preparations.

Note: The more we chew our food, the greater our ability to extract nutrients from it. Chewing also slows down food consumption to a pace at which our body has a chance to tell us when it has had enough to eat. It needs at least 20 minutes after chewing begins!

Muscles in the esophageal wall drive the food toward the stomach, entering through an opening at the esophageal sphincter. Once the material enters the stomach, it starts churning the food mechanically to transform large pieces into minuscule particles while subjecting them to potent gastric acids. Because these acids are as damaging to cellular tissue as they are to food particles, it takes a complex mechanism to regulate their production and secretion into the stomach. A thick mucosal layer protects the stomach lining from damage.

Note: The world’s healthiest, long-lived human beings eat to 80% of capacity, leaving plenty of room for the stomach to function effectively.

The stomach contents must be rendered to baby food consistency before they are deemed acceptable to the small intestine. The brain controls the pyloric sphincter which serves as the gateway between the stomach and small intestine. It empties into the small intestine as if feeding a baby – one small bite at a time. As such, the stomach serves as a storage facility for partially processed food until this rather slow process comes to fruition. Once all of the material has passed through the pyloric sphincter, the enteric nervous system runs the show.

Note: Now you know why the stomach can feel uncomfortably full for quite a while after an oversized meal!

The initial segment of the small intestine (a.k.a., duodenum) uses sensors to measure the pH of the incoming contents and leverages the enteric nervous system to signal for release of appropriate digestive enzymes by the pancreas. (All of that acid from the stomach must be neutralized!) The enteric nervous system also communicates with the liver and gall bladder (i.e., the storage repository for bile) to secure substances that emulsify fats so that digestive enzymes can process them.

The small intestine assumes primary responsibility for digestion and nutrient absorption. Folds in the intestinal lining combined with cellular projections on the cell walls (villi and microvilli) maximize the surface area through which absorption may occur. Tight junctions between cells in the lining keep undesirable materials from entering the bloodstream.

Note: For some individuals, certain foods cause the lining of the gut walls to lose their integrity. The resulting gaps allow oversized food particles and pathogens access to the bloodstream. Their entry sparks inflammation that may trigger an autoimmune response.

The small intestine transfers largely watery materials into the large intestine (a.k.a., colon). Of the roughly 2 gallons of water that the colon receives daily, all but 6-7 tablespoons are reabsorbed by the colon to prevent dehydration. Bacteria hang out in the colon and make up a good portion of excreted materials. Immune-competent cells in the lining shield the body from attack by “bad” bacteria. The brain steps back into action at the end of the line by regulating bowel movements.

Dr. Gershon provides insights on several common digestive ailments so that the reader can understand the biological mechanisms at play. I’ll confess that I didn’t explore all of them in detail. However, my elevated understanding of the entire system will certainly inform my food choices and eating habits going forward.

If you’ve already crossed the midpoint of your first century on earth, Dr. Sara Gottfried’s book Younger: A Breakthrough Program to Reset Your Genes, Reverse Aging, and Turn Back the Clock 10 Years might have some appeal. For while we can’t stop the ticking of the clock, there’s much we can do to make the time pass more pleasantly.

Dr. Gottfried tells us that genes only account for 10% of our body structure as we age. Our lifestyle controls the other 90% by virtue of its effect on our biochemistry and, therefore, the expression of our genes (a.k.a., epigenetics). If we want to look and feel younger, we need to make healthy lifestyle choices consistently.

Left unattended, five forces work against us as we age.

• The MUSCLE Factor: We accumulate fat and loose muscle.
• The BRAIN Factor: Our neurons lose speed and flexibility, and our brains resist mood-elevating estrogen.
• The HORMONE Factor: We make less estrogen and testosterone. Sluggish thyroids slow down our metabolisms. And we’re less adept at regulating insulin (to manage blood sugar) and cortisol (to control the stress response).
• The GUT Factor: Our intestinal health and quality of our microbiome (i.e., the colony of healthy bacteria that digest food and support immune function) either speed up or slow down our biological clocks.
• The TOXIC FAT Factor: Belly fat accumulates environmental toxins and causes more rapid aging.

Accelerated aging occurs when the body loses its capacity to clean up its daily damage – i.e., removing mutated DNA, improving sluggish hormone and enzyme production, and neutralizing highly reactive molecules (a.k.a., free radicals). The following conditions impede the body’s efforts to maintain itself in peak operating condition:

Fortunately, it’s never too late to build new habits. Our bodies continue to adapt to their environments – for better or worse – until we die. To that end, Dr. Gottfried provides a 7-Week program during which the motivated reader can transform his or her life. Here’s a brief summary:

WEEK 1: FEED. Get rid of processed foods. Eat homemade meals. Include 5-10 cups of fresh vegetables daily. Avoid common allergens (e.g., gluten, dairy) as well as sugar, sweetener, and caffeine. Minimize red meat and fat. Ingest collagen in bone broth or powdered form as it’s rich in antioxidants, lowers blood pressure, and improves bone density. Opt for organic red wine when drinking alcohol. Floss and brush twice a day.

WEEK 2: SLEEP. Make sure you get 7-8 hours of high quality sleep every night. Sleep promotes physical restoration, memory consolidation, and brain detoxification. Avoid stimulants and artificial lights at night. (Use blue-blocker glasses after sundown if you can’t avoid artificial lights.) Make the bedroom conducive to sleep.

WEEK 3 MOVE. Integrate physical activity into your day. Excessive sitting weakens bones, atrophies muscles, promotes organ damage, impairs circulation, and causes back issues. (If working in an office, alternate between sitting and standing at your desk!) Get at least 150 minutes of moderate (or 75 minutes of strenuous) aerobic activity each week. Increase muscle mass through strength training.

WEEK 4: RELEASE. Find ways to release the tension and habitual tightness that builds up in the body. Yoga and other forms of release clear stress, increase range of motion, boost respiratory health, and improve recovery time. They also supports the body’s mechanisms to supply fresh nutrients to tissues and whisk away toxins and chemical byproducts.

WEEK 5: EXPOSE. Increase intake of key vitamins, minerals, fiber, and nutrients to strengthen the liver’s ability to collect and process the body’s garbage. Eat foods rich in antioxidants – e.g., leafy greens (especially kale, broccoli sprouts), berries, organic walnuts, green tea. Use natural cleaning products (or make your own). Take saunas, steam baths, or hot water baths with Epsom salts to encourage the body to sweat out the toxins.

WEEK 6. SOOTHE: Eliminate stressors or find effective ways of coping with them. Add new responses to your defaults – e.g., prayer, mindfulness, yoga, meditation, qigong. Connect positively with others. Get enough sleep!

WEEK 7: THINK. Change the perception of your external environment to create a healthy internal environment. Create new neural pathways such that your self-talk becomes loving and supportive. Cultivate an affirming community of friends.

This brief post hardly does justice to the wealth of material in Dr. Gottfried’s book. Hopefully, it encourages a deeper dive!

For the past several years, my husband’s physicians have been trying to get him to take statin drugs to manage cholesterol. That recommendation struck me as odd given that his serum cholesterol is relatively low, and he maintains a healthy weight and diet. Moreover, a good friend developed severe muscle pain and weakness when she took statins. So my husband opted to take a pass.

Dr. David Perlmutter, renowned neurologist and author of the international best-seller Grain Brain, would applaud my husband’s decision. As it turns out, 60-70% of our brain matter is fat. (Yep – “fat head” is an apt description for all of us!) Our brains rely heavily on a steady supply of cholesterol as an antioxidant to quell inflammation and as a source of energy to grow and sustain neural synapses. Low Density Lipoproteins (LDLs) capture this life-giving cholesterol and transport it to the brain. Statin drugs diminish the body’s LDL supply which reduces the brain’s access to cholesterol. When taking statins, some folks experience cognitive impairment, confusion, and memory loss as a result. Stains also interfere with the brain’s serotonin receptors, leading to a higher risk of depression and suicide.

Statin drugs also disrupt production of coenzyme Q₁₀ (CoQ₁₀), a fat-soluble substance known to be an important nutrient for the heart. Low levels of CoQ₁₀ give rise to fatigue, muscular pain, and problems with mobility and balance.

As a post-menopausal woman, I was especially alarmed by a couple of statistics that Dr. Perlmutter shared. In particular, post-menopausal women who take stains have a 48% increase in risk for diabetes. Having diabetes doubles the risk for Alzheimer’s disease!

So how do we reconcile these facts with a multi-billion dollar statin market? Aren’t high levels of LDLs associated with increased risk of coronary artery disease (CAD)?

Statin proponents frequently cite the JUPITER Study in which participants on statins experienced 31 heart attacks and those on the placebo experienced 68. This simple numeric comparison suggests a 58% reduction in relative risk. However, given that the experiment and control groups each had nearly 9,000 participants, the overall risk of heart attack went from a very low 0.76% in the control group to 0.35% in the statin group. Thus, the minimal protection one might achieve needs to be weighed against the high percentage of people who have unwelcome side effects from the drug.

The answer to the second question appears to be yes… and no. Healthy LDLs are not a risk for coronary artery disease. They go about their business and leave the surrounding tissues alone. However, when excess sugar molecules in the blood stream attach themselves to LDLs, the LDLs become oxidized – i.e., lose electrons and transform into free radicals. They cease to function properly and become “sticky” when encountering the tissues surrounding the blood vessels. Once these tissues are damaged by oxidized LDLs, inflammation starts. When the body’s immune system deals with the inflammation, foam cells build up. That build-up leads to arterial blockage.

Dr. Perlmutter’s findings align with Drs. Bowden and Sinatra’s book, The Great Cholesterol Myth. Eating foods high in cholesterol doesn’t give rise to CAD, per se. Diets high in sugar, processed carbs, et al do! That being said, we don’t get a free pass to ingest a bunch of fats. Every author I’ve read lately admonishes readers to focus on consuming healthy fats (Omega 3s) and limit intake of unhealthy ones (Omega 6s). Omega 6 fats are precursors to inflammatory compounds; omega 3 fats are anti-inflammatory.

Prescription drugs certainly save lives. Though I am not a trained physician, I expect that there are patients whose conditions merit serious consideration of pharmaceutical intervention via statins. However, my husband and I prefer to make dietary and lifestyle choices to improve our well-being and use medication only when absolutely necessary.

In the treeless grassland of Eastern Africa, a herd of zebras enjoy the noonday sun while catching an occasional bite to eat. Suddenly, a lion sprints toward them in search of a fresh supply of meat. As the herd scrambles to escape the predator, each beast experiences the “stress response” as their bodies:

• Mobilize energy (glucose) in their bloodstreams to provide fuel for their muscles
• Elevate their heart rates, blood pressure, and breathing to expedite delivery of fuel and oxygen to their cells
• Halt long-term “building projects” – e.g., growth, tissue repair, reproduction
• Boost immunity and blunt pain response
• Sharpen senses and improve memory

These innate biological mechanisms share a common goal: Keep the beast alive during a (hopefully) relatively short time frame. Minutes later – once the threat has passed – the survivors regroup at a safe distance. With their stress response abated, they’re free to skip along the grassland, wag their tails, and grab a bite to eat.

All of the same mechanisms activate when human beings are subject to an acute crisis (e.g., running from a saber-toothed tiger) or chronic physical challenge (e.g., going on long excursions to forage for food). Fortunately, most of us avoid these stressors in the modern world. Yet we have another set of stressors up our sleeves. We have the capacity to put our bodies in an uproar by the thoughts we think. That kind of stress can hang around for hours, days, or months on end, causing great damage to very bodies that our stress responses were designed to protect.

In Why Zebras Don’t Get Ulcers, Dr. Robert Sapolsky provides a detailed account of normal functioning of many of our physiological systems and processes. He then recounts the deleterious impact of too much stress, including:

• Hypertension, causing arteries to stiffen and heart muscles to thicken
• Excess circulating fatty acids and glucose in the bloodstream which lowers HDL (good cholesterol), elevates LDL (bad cholesterol), promotes insulin resistance, and increases fat deposits around the abdomen
• Disruption of normal digestive function
• Bone disintegration due to reduced calcium supply and inhibitory effects on cell division
• Suppression of the immune system during prolonged stress response activation to conserve energy and avoid “friendly fire accidents” (i.e., shooting the body’s own tissue versus an invader)
• Memory decline as neural networks get disconnected and new ones fail to thrive
• Sleep deprivation due to insomnia and decline in overall sleep quality

Stress pundits offer the following coping strategies to lessen the impact of stress: (i) Differentiate threatening from neutral interactions – i.e., don’t make mountains out of mole hills; (ii) Exert some control over social conflicts – even if it simply means choosing one’s attitude toward the stressor; (iii) Displace frustration – or as Duke Ellington would say: “I merely took the energy it takes to pout and wrote some blues”; and, (iv) Make social connections. Dr. Sapolsky’s preferred stress-reducers include:

• Cognitive Flexibility: In the split seconds between racing heartbeats, have the presence of mind to get centered and choose an appropriate course of action. Eighty percent of stress reduction happens with the first 20% of effort. Don’t wait to dream up the perfect response. Just do it… and be prepared to adjust as needed.
• Exercise: It decreases cardiovascular risk while releasing endorphins that make you feel good… so long as the activity is something you want to do!
• Meditation: It calms the mind and body while lowering levels of the glucocorticoid hormone that wreaks havoc when active too long.
• Social Support: Find support from the right people at the right time.
• Daily Practice: Do some form of stress management daily. Cultivate an optimistic attitude. Control what you can and let go of the rest.