The Metaphor of an Oceanic Disease Sidney MacDoneld Baker, MD ‘Symposiuin in Tampa, Florida, triggered in me @ series of epiphanies that | think are most appropriately cataloged funder what 1 call ceanie disease or. pecvaps, the systemic epi- demic. OF, it may’be best to call my ideas the oceanic metaphor to ‘make it clear that a disease is nota thing but a concept. ‘This metaphor states that we practitioners will do better if we believe that theze ate fee diseases and many kinds of people rather than that there are few kinds of people and many dis- ceases. Recognining that the problems of our healthcare system cannot be solved without promoting health—rather chan treat ing disease depends on understanding that our problems are bath ecological and logical. That isto say, not only based in our environment, but als logical in contrast to what all thecurtent nonsensical, “names blamesit, and tameit prescription pad medicine.” tn this type of medicine, through our thinking and speaking, descriptions of disease ace assigned causations of disease ‘My idea can be expressed inthe following self-created parable ‘Numerous groups of indepen lent expeditions have traversed a dense biochemical and imamunologt ‘callandseape co seek the fundamental ‘cause of autoimmune problems, can cer, dementia, heart disease, and other aflietions of modern affluent societies, Some of the best teams were well financed With vast funds left over from more fashionable research tha involved looking up tothe stars for genesic causes and to the clouds for pharmacological solutions. The wi cing teansin my parable, however, have their eyes nt onthe sky ‘nut do on the ground of basic biochemist. They are blazing «tral that at lst breaks into a clearing overlooking an ocean, Arriving atthe clearing, 1 team of cancer cesearchers eealizes there ate also cardiovascular researchers present and say, “Mey, ‘what are you cardiovascular people doing tere? You mast be lost ‘This isthe ocean from whose depts, currents, and winds comes the forces that cause cancer!” [n response, the cardiovascular researchers say, "Why, no, This is the ocean of heart disease, We have taveled along and complex path to artive hee.” By the end ofthe day, however all he various specialists conclude that they, ‘emerging from diferent tls, have reacted the sae ocean from wich come the same causative forces of disease. The “Torces’ of my parable are problems of oxidative stress, detoxication, and inflammation, which are joined by their common feature, glutathione (GSH) attrition. Between them, chey generatea map ofthe basic landscape in which aff I: 2006, the 13th Institute for Functional Medicine Integrative Medicine + Vol. 7, No. 1+ Feb/Mar 2008 Nie nt societies ereate common chon illnesses, represented by the Venn diagram shown here. “This diagram was the fist part of my Tampa epiphany. which began a [listened to Colin Campbell, Fu, tll the story behind his book The China Study (Benbela Books, 2005 which II describe in more detail later. My epiphanies continued through the surnmer of 2006s steed to all the Fampa speak- ersover and over again on my iPod The biochemical setting they described, illustrated inthe above diagram, was the same one that had emerged over the past several yeats forthe causes of autism, {vas stunned to realize thatthe very spciliad prob lems of autism were not specialized at al, but part of avast — therefore “oceanie"—pucae. The inticaces ofthat puzle have bothered me verthe cours of ty 40 yeers in medicine ‘as Fe watched the increase inal sorts of “unre fated” and increasingly prevalent chronic siscases such as Aleheimers, asthma and other allergic reactions, auto-immune troubles, breast eancer, cardiovascular issues, and developmental and atten tional difficulties. “These prablems, so prevalent it affluent societies, were conspicuously absent om the cultures of 2 of the work’ poorest countries, Nepal and Chuad when practiced meine therein 1950 and om 1966-1968, respectively. The Door Opens ‘Whats the pst of what was said in Tampa? ‘Nutttion, environmental pollution, andl other eo logic stressors have increased the incidence of many chronic diseases that the scientific community (represented by the speakersat the conference) now sees varied expressions ofthe same undying inflammatory processes. How does it work? And how does understanding how it works give us a better handle on prevention and cure than ‘nvcrely tveaking the biochemistry of individuals with drugs or supplements or dodging toxins and allergens? In my past efforts to help patients set priorities among their options for solving the problems of chronic illness, Ihave focused on identifying ays the genetic arrow is deflected from health so disease by layers of their individual physiology Ive continually tried to se how each patients constitation—how fever genetics and environment have conspired t0 shape it— might benefit rom corrections to those layers of physiology. In my 35 years as an integrative medicine doctor con- «cemed with restoring balance to those Layers, have struggled in the gap between general and specifi remedies. Should [begin kh Map ene Daeby asking all my patients to adopt a "healthy lifestyle" and build one-size fits.ll approach fo physiologic balance? Or shoul 1 Sind anu fica patient’ special unmet need(s) for some necessary therapy or help him or her avoid and/or eid some noxions toxin() or allergen(s?? I would never argue an ether-or ease, | am drawing the distinction here merely to frame the impact that my oceanic metaphor has had on the weight Ive assigned tothe general versus specific strategy in my clinical repertoie Before Tampa Idd not really understand the general prob Jem of oceanic disease. Moreover, my understanding of liness asa signal to change led me up a due path for assessing balance in individuals: Maybe this person is lacking something that ‘would be good or getting something tha isbad. My own grasp focused on specific individual quisks in my patients’ webs of capacities to take in, process, andl express the effects of mute ets, light, chythmie integration, and love, and to avoid or detoxify allergens and toxins, Early in my career T though hat this simple “get and avoid” approach would be a long shot both for patients with wellcharacterized diseases like lupus or juve nile rheumatoid archits and others whose problems had not bbeen dignified with an acronym ot an eponytn, But over time, experience reassured me ofthe clinical results achieved by tak- ing a systems appeoach—es opposed to tinea thinking—th explored the webs of causation in a leisurely conversation and respecte the patient's intelligence and intuition. Chain smokers, aeoholics, and junlefood junkies with hoeayy environmental exposures don’ comne io see me very often, and those who do have anticipated that thie illness is signal 10 change. Thos, shen my more circumspect patient's ecological problems does not appear tobe a candidat for some sort of gen tral cleanup, Ihave found individualized "eco-analysis” a more inviting path of discovery than a prescription of some generic vetsion of Baker protocol for healing, My instinct in addressing patients with cheonic illness has always been to hegin with the specifies and later work toward the universal ‘This changed in Tampa. Each of us has al both good and bbad moments in our lives after which nothing was ever the same. For me, Tampa was one ofthe best in my life as a phys cian, Viewed from my patient oriented perch, | may have an accurate impression that, down the road, the Tampa sympo- sum will appear in the historical rearview mirror as the time when serious, mainstream scientists gathered to talk about detoxication and found themselves in the metaphoc I have \leseribed-—a common ground that lies beneath the pathology of most of our society’s chronic illnesses. Ifthe Venn diagram above is an accurate portrayal of that common ground, the implications for healthcare ate whopping, The Example of Autism Ay interes in the biochemistry of autism had led me to understand he canaly of hia eheistty—fom methionine to {GSH[—ith its implication that autism isa chronic inflammatory ness at nvles problems of oxidative sess and detoicatio. “The fest pact of my enltspat Tampa epiphany was under standing that the Venn diagram isthe shared endscape of all of the chron linesses under discussion atthe symposium akrThe gr 9a Oss Die The second par of my epiphany was to realize that, de to this, my particular interest, autism, i not.a special case, As such, autism is basically one manifestation of that common {ground ina growing numberof children in our culture ‘The tic part of my epiphany was the realization that cu rently accessible, welhfunded, high-level, published research on the cause and prevention of major diseases that “have nothing 10 do with autism” ean and should inform both private and public poe concerned withthe prevention and cure of autism. Specifically, this researc tellus that the autism epidemic is @ manifestation of the same forces driving the other major health problems of our society. Sadly, far rom being a special ease, atin just may be the worst-case expression of a shite in public health, Why worst case? First is thatthe historical response to autism on the pat of professionals has been to tell parent, “Don’t look for answers"—adviee that is neatly unique ina world where “heroic" measures ae the norm. Second, pubs lic dialog has been especially polarized as to the incidence, temporal trends, and environmental factors that could bear ‘upon the condition, Third, in my opinion, autism has affected some ofthe best and brightest of our eildcen Thisshift in public health to ever more increases in chronic disease has given ise to maifestations of cildhoe problerin ‘nvmane and cogitie perception ranging from peanut allergies to various problemsin regulation of mong, attention, and behav ior Keepin mind that the immune and central nervous systems are funetonally unitary: memory and perception. The volners bilty of young immune and central nervous systems puts our cfilden inthe role of canaries in our ecological eoalmine ‘The biochemistry of autism—as described by Boyd Haley Chairman of Biochemistry at the Univesity of Kentucky —is a biochemical train wreck, In that mess, what are the central Faults that correspond to break i the tacks? And what isthe collateral damage? One way (© think about the differences Detiveen the primary and sesondary aspects of autism’ bio chemical web isto look at measures that show very large differ ences betveen autistic and normal eileen Diflerences of severafold (200% or more) ae infrequect in medical sts which 18% ilference can, with robust mus bers of subjects, indicate a statistically significant margin that “proves” we can bank on the diference to cive clinical decisions. TTefallowing autism studies, however, shows differences of sever aHfld Firsts the stacy by Holmes Bll, and aly, document ing low levels of hair mercury infants who later became autistic as compared to those with higher far levels of mercury who did sot! These resis were replicated by Adams The ifferences were 7a in the first study and fold in the late. These 2 stds demonstrate a severe detoxication impair iment inchldren on their vay to becoming autistic because Lover hair mercury indicates lovee capacity to rl the body of mercury ‘Moreoser, the Adams sty shows a dose-response elect of lover hair mercury in children with more severe autism, which provides {he second ofthe rts generally aecepted as necessary for st tlic poof temporal priority. dose-response ele, lack of spur us factors, and biological plausibility These tus ae published in the peer reviewed itrature, aml they have nt ben challenged hori Integrative Medicine + Vol. 7, No, 1 + Feb/Mar 2008 ©a by any study with contrary esl Other findings of many-fold differences eonceen pro inflammatory lymphocyte counts? and eytokine levels in the ut- associated Iymphoid tissue (GALT) of autistic children ver: sus normal controls and another group of non-autstic children with inflammatory bowel disease. The differences in intraepi thelial CD3 and CDS lymphocytes were several-fold, and the diferences in the pro-inflammatory cytokine tomor necrosis factoralpha were more than an order of magnitude. These measurements not only give credibility to parents’ descriptions of inflammatory hovel symptoms in autistic childeen, but siress inflammation a a primary feature of autism, The studies showed thatthe lnphocyte profiles and cytokine levels found in the GALT of autistic children not only distinguished them fiom otal contruls but also were also far more abnormal than those of cildten with Crohn's disease and ulcerative cal tis. Purthermore, there is evidence of inflammation in the brains of autistic childcen, as shown in the studies of Pardo, Vargas, and Zimmerman from Johns Hopkins University.® ‘Osidative stress, the third component in the Venn die gram, is documented in autism by the work of ill James, PRD. ‘She has sown dramatic eliffecences (P<.0004) between autistic children and oormat controls in serum levels of reduced GSH, slutathione disulfide (GSSG). cysteine, and GSH/GSSG in their precursor thiols. ® The 3 common breaks in the tracks of autistic children’s biochemistey include: oxidative stress, problems ‘with detosiation, and inflammation. Lowy GSH isthe link that joins the 3. The many other bioclemical and immunological problems that we document in our autistic children are nothing ‘move than collateral damage from the train vceck. The Role of GSH ‘A fourth part of ny epiphany was the realization thatthe chemistry of oxidative stress, detoxication, and inflammation ‘constitutes an arrangement of nested vicious cycles, The bad thing about vieious cyclesis that they are self perpetuating. The good thing about them is their capacity for restoration of the vicious to the virtuous eyces from which they came: Lack of GSH causes oxidative stress, which then poisons thiol chemis- uy, which impairs detoxication, which provokes inflarana tion-—which further lowers GSH production, which causes more oxidative stress, which impairs detoxication, whieh poi- sons thiol chemistry, which again provokes inflammation, and 50 on. Lowering oxidative stress by restoring GSH and remav ing toxins (such as heavy metals) hat impair Key thiol enzymes can restore vistuous cycles, Nature's strong impulse toward healing is embodied inthe restoration of virtuous cles, The fifth part of my epiphany was learning about the dietary induction af GSH. Instead of fretting over the question of whether GSH levels ean be raised by any route of administra tion (or by pushing its precursor, N-cetyleysteine), does it not make more sense to induce increased formation of GSH? In ‘Tainpa, Albena T. Dinkovs-Kostosa, PhD, of Johns Hopkins presented the case for broccoli sprouts as the best among a whole series of foods with GSH-inducing effets. Dr Jim Slaga presented the case for his ist of superfoods (some of which are Integrative Medicine + Vol. 7, No. 1+ Feb/Mar 2008 listed below’ that share a capacity for GSH induction. Foods, it turns out, are more powerful in achieving the goat of modat ing oridative stress than supplements, precursors, or drugs (although, under special cireumstances, targeted intervention in thiol chemistry i very effective) The Role of Phytonutrients ‘The sith part of my epiphany was new understanding of ‘what we cll phytonutrients, The total number of plant species ‘om earth may he in the range of 310000" to 422000.8 However, even the most varied human diet—a, for example, that of hunter gatheres whose fod sources may consist of more than 100 diferent plant species made up of sed, oots, stems, Now «5, and evits—is only tiny factional th ert’ plants. The ‘modern supermarket displays only a fraction of that feotion and mostly conss'sofstarch, sugar, anal protein and fa, and some refined vegetable ol. Most phytonutrients ae plant toxins. We donot se ot oflving plans that are overwhelmed by mamas, brs, ep tile, amphibians, insects, worms, fungi, and bacteria. Why? Plans defend themselves. They may offer certain pats fo con- sumption, forthe sake of reproduction and the dstibution af their seeds, but for the most part plants defend against being eaten by producing an array of badsasting substances that rend them tose od inedible tous aad most other creatures, as wells resistant to myriad of sess, ong, and bacter ‘The portions ofthe few plants to which we humans are adapted and tht form the basis for agscltre contain toxins thatimpatintrsing biter o otherwise complextastes that we coy. Dr Slga dette such phytomatrient rich super fools as, black currants, blubervies, chocolate, cote, gatic, ginger, onions, pomegranates, rosemary, spinach, teas, turmeric, ad the whole ange ofthe cabbage family (Brain) of plas, ‘whichncldes arugula oko, brocel, Brussel sprouts, cb tage, caulilvet, cllard greens, horseradish, kale, kohlrabi, snustard radish, utabag, turnips. wasabi, and watercress, Tie tains in these and othe pants go by many dierent names a vary the waysin which they speak to ou biochem. istry, One of sr basic messages to tr body, however, sto up. regulate production of certain molecules suchas GSH that are needed for thst detoxiaton. A side bent is ther detox tion of used hormones and other endogenously produced sub stances, a ell environmental toxins As sh, these plans constute 3 nuttonal influence in our dies that only recently has been understood. That influence deserves growing impor tanceamong ou dietary coicesbasedon the knew ntitional importance of vitamins, minerals, and essential ty and anno acids, wbich ave been the backbone ofmcronutrent edeation thing my cree sa mutitionaly oriented physician “he seventh part of epiphany was sn understandingof wy we should eat organic foods. though it was becesoe organically grown foods were fie of pesticides an richer in nutrents Right? Right! But even more right isha onganelly grown foods are more abundant in pytmutiientss seeranen, tha the plan wil cuca if they ace not being bane by he pests tha have been banished by pesticides i" Baker—The Man of an Croc Deane