No one wants to be sick or feel pain or have a life-threatening disease. All of us want to have optimal health. A good definition of optimal health comes from the American Holistic Medical Association: the conscious pursuit of the highest qualities of the physical, environmental, mental, emotional, spiritual, and social aspects of the human experience. The mindful person can do a whole lot to pursue optimal health, particularly since the factors that have the greatest influence on health are under his or her control. Western society still places too much emphasis on genetic makeup as a determining factor in human societies. This is an unfortunate and destructive leftover from the deterministic, racist and classist science of the 19th and 20th centuries. Back then the aristocrats who controlled science and medicine proselytized that just about every human feature including intelligence and personality was determined by the genes. Now the more modern science has proven that ALL human features come from interactions between the genes and the environment. Nowadays even the most fervent geneticists will freely admit that genes do not operate in a vacuum; it is impossible to separate the actions of genes from the environment in which they are acting. And while we as individuals can't change the genes we've inherited we sure can change the environment in which they have to work. Accepting that we have the power to do this gives us power to avoid disease or at least to delay its onset and progression. Medical practice continues to improve in technological sophistication. Organ transplantation, mechanical and electronic tissue implants, and now stem cell proliferation to replace dead or dying cells—all combine with improved techniques for disease detection to improve the average length of life in the society. But very few among us can benefit from these improvements, simply because the technology is incredibly expensive in time and money. And there are no guarantees—the rich patient in his private suite may still be struck down by a roving super bacterium or a slip of the surgeon's scalpel. Luckily for those of us who have to work for a living, a sophisticated body of knowledge is now available about the causes of ill-health and disease. The major causes are now mostly identified, there is pretty good understanding of how they work, and they can be managed to keep their negative impact to a minimum. For all the planet's citizens who seek some control over their lives, making a commitment to eliminating these disease factors is the most commonsense chance for staying healthy and reaching a ripe old age. Late last year I turned my attention to Parkinson's disease (PD). The medical and basic science research done on PD has produced an important model for understanding all disease. First, several causative factors are involved, all of them working together to initiate the disease and drive its progression. In a small proportion of the cases there is evidence for inherited susceptibility—“bad genes”—that could cause the disease to appear before the age of fifty. But the vast majority of cases appear after fifty. Internal toxins contribute to the disease—oxygen free radicals overproduced by the body's own cells. I also found that external toxins are involved—toxic metals such as mercury and manganese, and pesticides (insecticides, maybe also herbicides). As I became familiar with PD I realized it was a proven model for the multicausality of disease. In previous times disease was mysterious and seen as a static entity-something bad that had invaded the body. Nowadays, the medical understanding of disease and the approaches to diagnosis have gone through a radical shift, at least among the more progressive physicians. These physicians emphasize the details of the medical history, making their best efforts to detect unique life experiences that may combine with the individual's unique susceptibilities and specific lifestyle to generate a particular symptom pattern. Many patients may not have a single precise diagnosis but can be made well anyway, through careful and systematic elimination of these causative factors. For the vast majority of patients in the modern medical practice, the causative factors are all too familiar.2 It is likely that just about all the chronic diseases and conditions of ill-health that strike adult humans have multiple major causes. These major causes are relatively few in number, and in each case—whatever the disease—if they can be managed or eliminated the patient's life should improve. A short listing includes: •
Individual susceptibilities: the person's predispositions and weaknesses,
outcomes of gene inheritance interacting with specific life history Let's deal first with the issue of genes and individual susceptibilities. The genes carry the blueprints for life, but real life comes after the genetic blueprint is translated into biological molecules with structure and function. By looking only at genes the Human Genome project didn't teach us much about life. It is the unfolding of the genes' potential within the protected cell environment; the cooperative interactions between the communities of cells in tissues; the higher-level coordination of the tissues into organ systems, all overseen by the mind, that make us what and who we are. And all this varies enormously from person to person. In PD, no more than 10-15% of all cases have a clearly defined contribution from “bad genes,” and all these appear before the age of fifty. Among the “typical” PD cases over age fifty, there do appear to be innate susceptibilities which could be related to some combination of specific gene flaws. One of these is a marked inefficiency in an important enzyme complex that helps generate energy. This complex (Complex I of the mitochondrial inner membrane) has its activity reduced by up to half, resulting in elevated production of potentially harmful oxygen free radicals (oxyradicals). The abnormality was found not only in the brain but in the platelets, suggesting it could be common throughout the body. And it just so happens that PD comes up in a part of the brain perhaps most vulnerable to oxyradical overload—the substantia nigra or SN. Oxygen free radicals are highly reactive and contribute to all disease. Normally they are controlled as far as possible using the body's natural antioxidant defenses. The most healthy SN is only lightly equipped with antioxidant enzymes and has built-in susceptibility to oxyradicals. In the PD scenario, the normally vulnerable SN is subjected to an abnormally great oxyradical load due to the Complex I malfunction. As the years go by the SN is living more and more “on the edge,” progresively capable to manage its burden of oxyradicals. Then some toxin or more likely a combination of toxins comes along from outside the brain, and this added toxic load finishes off the SN. The symptoms of PD then emerge. The added load of toxins coming from outside the brain to trigger PD could be any of the tens of thousands of known toxic substances. One major likely culprit is mercury overload, most likely due to the presence of dental amalgam fillings in the teeth (consisting of 50 percent mercury, the rest silver, copper, tin and zinc). A 1989 study carried out in Singapore found a link between body burden of mercury and PD. The researchers compared 54 cases of PD against 95 non-PD subjects. They looked at mercury levels in the blood and urine, and found that relative risk for PD was 8.5x in subjects with blood mercury above 5.9 nanograms per milliliter and urine mercury above 6.8 nanograms per milliliter. A nanogram is one-billionths of a gram and a milliliter is one-thousandths of a liter. Dentists working with mercury fillings in Singapore averaged above this range and unexposed office workers averaged below it. The issue of mercury in dental fillings has been controversial since the practice was begun in 1832. Both the chewing of food and tooth brushing release mercury vapor into the mouth cavity, and these levels can reach up to one hundred times the U.S. Environmental Protection Agency's maximum allowable concentration for air quality (0.3 parts per million). The handling of mercury in a dental office is now subject to all the hazardous waste disposal regulations that apply to other materials, but this careful disposal occurs only after the dentist has placed mercury into your mouth! The Singapore finding raises a karmic possibility: that the dental community which as a whole denies that amalgam fillings pose any risk of harm, may themselves be at high risk for damage to their health. For the person with mercury amalgam fillings, personal habits of chewing gum, grinding the teeth and breathing through the mouth will greatly increase the daily exposure to mercury. After it is breathed into the lungs from the oral cavity, 74% to 100% of it can be absorbed into the bloodstream and distributed throughout the body.1 There is talk about mercury entering the human food chain through accumulation by food fish, but rarely is it heard that a far greater amount of mercury can enter the body from dental fillings. Toxicology research has demonstrated that there is no threshold level below which mercury exposure can be considered harmless. The dental associations of the U.S. and Canada are under a lot of pressure from citizens challenging their positions that mercury-containing amalgams as safe. After releasing a grossly misleading “informational” brochure for years, in one lawsuit the U.S. ADA took this position: The ADA owes no legal duty of care to protect the public from allegedly dangerous products used by dentists. The ADA did not manufacture, design, supply, or install the mercury-containing amalgams. The ADA does not control those who do. The ADA's only alleged involvement [in placing mercury amalgam in patient's teeth] was to provide information regarding its use. Health authority and activist Gary Null makes the important point that while holding this legal position the ADA failed to mention that it holds patents on mercury amalgams, is responsible for certifying all dental schools in the United States, and has attempted to intimidate and harass dentists who challenge them on this issue. No way can the ADA claim not to be involved in the large-scale contamination of the population with mercury. Another likely major causal factor contributing to the total toxic load in Parkinson's is pesticide use, particularly indoors. This disease first appeared during the Industrial Age, and a connection has long been suspected between PD and the drinking of contaminated well water or agricultural or industrial exposures to insecticides or herbicides. Workers with exposures to multiple pesticides have a higher risk of PD, and recently a group at Stanford University conducted a substantial study on this subject. At Stanford U's School of Medicine Dr. Lorene Nelson's group did a study of 496 persons diagnosed with PD and compared them with 541 closely matched controls. Using structured interviews, they determined that home exposure to insecticides and herbicides was associated with increased risk for PD. In-home insecticide exposure posed higher risk for PD (2x) than did outside gardening with herbicides (1.7x) or insecticides (1.5x). These are the toxins most closely linked to PD at this early stage of the research, but virtually all known toxins are capable of depleting the body's antioxidant resources. Nor can we rule out “lifestyle” toxins such as the huge load of free radicals carried in cigarette or marijuana smoke. There actually is a human “model” for PD. This comes from an accidental tragic series of toxic exposures. In 1982, drug addicts in northern California began to report to emergency rooms with severe Parkinson's-type symptoms that had rapidly developed after they injected a new synthetic heroin. This heroin material had been manufactured by amateurs and came out contaminated with a substance called MPTP (for MethylPhenylTetrahydroPyridine). Within a matter of days following intravenous injection the MPTP had wiped out the SN (substantia nigra), the same part of the brain that degenerates over years in PD. MPTP was later confirmed to be a highly oxidative, “free radical” substance that depletes the flimsy antioxidant defenses of the SN. Pesticides, herbicides, and mercury all have strong oxidative character. Normally, free radical and other oxidative stressors are delicately controlled by antioxidant enzyme systems, working in harmony with nutrient antioxidants such as vitamins C and E, coenzyme Q10, and glutathione and with metabolic cofactors such as the B vitamins. Whenever the nutritional supply of antioxidants and cofactors drops, the body's antioxidant defenses also are impaired. At these points the body's load of toxins from the outside can tip the scales in favor of antioxidant breakdown that leads to functional loss and disease. Parkinson's features progressive depletion of the key antioxidant glutathione in the SN; at his clinic in Naples, Florida Dr. David Perlmutter often can see dramatic improvement in his PD patients once he gives them glutathione. He also uses an integrative program with other antioxidants and nutrients. This disease-causing synergy between innate vulnerability, internal production of toxins, and added toxic load from outside the body is very likely not restricted to PD. As far as the brain is concerned, there is evidence that Alzheimer's, multiple sclerosis (MS), and maybe also amyotrophic lateral sclerosis (ALS) all have such causative contributions from toxins. The idea that a disease can have multiple causes is not new, of course. Nor is Parkinson's likely to be the only multicausal disease—it is probable that all diseases have multiple causes. Infectious agents are far more important causal contributors to chronic disease than was earlier believed. Previous over-prescription of antibiotics may have contributed to their resurgence in more aggressive forms. They siphon life energy away from the host tissues, generate inflammation which further damages the tissues, and can derange immune mechanisms to trigger autoimmune problems. Autoimmunity (reaction to self-antigens) is a suspected major factor in arthritis, inflammatory bowel diseases, MS, lupus and many other diseases. HIV-1 causes changes that amount to systemic inflammation; the hepatitis viruses B and C are linked to liver inflammation and cancer, the human papilloma virus (HPV) to cervical and perhaps also colorectal cancer; the bacterium Helicobacter pylori to stomach ulcers. Human herpesvirus 6 (HHV-6) and Mycoplasma bacteria are also major contributors to total infectious load. Drs. Garth and Nancy Nicolson of the Institute of Molecular Medicine in Huntington Beach, California have used highly sensitive PCR (Polymerase Chain Reaction) testing to look for infectious agents in chronically ill patients. They found that about half of the chronically ill American veterans of the Gulf War have mycoplasmal infections, some of them more than one species. Mycoplasmas are the simplest present-day cells, tough parasites that enter the human cell and take over its machinery. They can be eradicated using antibiotics but only with long treatment times. The Nicolsons report that about 50% of the rheumatoid arthritis patients they studies had mycoplasmas, as did 60% of their chronic fatigue patients, 70% of the fibromyalgia patients, and 85% of ALS patients. Within the control population no more than 9% had mycoplasmas. The Nicolsons suggest that these chronic illnesses are probably due to a combination of multiple toxic exposures, chemical and/or biological, in combination with innate susceptibility. Still another major causal disease factor is the pro-inflammatory body balance of most of us living in the industrialized countries. Inflammation is a type of controlled free radical response to a wound or a localized infection. Properly controlled, inflammation is not a bad thing—it lasts for a short time and successfully eliminates the offending agent. But sustained, ongoing inflammation can increase the body's toxic load and promote many types of diseases. As examples, atherosclerosis appears to be mostly an inflammatory disease, as does osteoporosis. Alzheimer's likely has an inflammatory component, and cancers are likely to be promoted by pro-inflammatory balance. Total toxic load, total infectious load, and total lifestyle burden all promote chronic inflammation. There is good evidence that the body has a “set-point” between pro-inflammation and anti-inflammation, and that the typical Western lifestyle and diet promotes a harmful pro-inflammatory balance. High free radical-toxic burden will encourage inflammation. So will dietary or constitutive insufficiencies of antioxidants and metabolic cofactors. The pancreas is notoriously poorly equipped with antioxidants, and adult-onset diabetes from pancreatic failure is now epidemic. On the more positive side, a net anti-inflammatory balance supports long-term health. In addition to generous intakes of antioxidants and all the usual vitamins and nutraceuticals, another powerful tool against inflammation is the omega-3 fatty acids. Dietary supplementation with DHA- and EPA- fish oils is highly anti-inflammatory and strongly protects heart attack survivors against second heart attack, as well as protects the prostate against cancerous transformation. Parkinson's disease, our model for multicausality, also has an inflammatory component. Dr. Langford's group in California pioneered the research into MPTP, the heroin contaminant. As the years passed they kept in touch with the small number of subjects who were briefly exposed and survived. Three of them were autopsied at death, and all showed clear signs of a progressing inflammatory process very similar to PD. Though they had used MPTP for less than a week back in 1982, inflammation apparently had begun at that time and continued to eat away at the SN—for as long as 16 years in one subject. One brief but intense exposure to a toxin had initiated a long-lasting inflammatory progression. These unfortunate souls might have had a better life with high intakes of antioxidants and omega-3 fatty acids, the body's natural anti-inflammatories. We
don't have much control over the genes we're born with, but we surely
have some control over the things we choose to put into our mouths
and our veins and other parts of our bodies. Infections, bad health
and disease are not mysterious: they don't just come out of nowhere.
If we can be more vigilant in paying attention to our total toxic
load and our total infectious load, if we can clean up our total lifestyle
burden, if we can become active in ridding our homes, workplaces and
communities of toxins, we have the chance to override our genetic
limitations and enter the dimension of optimal health. |
