16 February 2010

Stayin' Alive : Learning About our Bodies

Apples and oranges: Rats have substantially different physiological systems.

What do we know about our bodies,
And how do we know it?

By Mariann G. Wizard / The Rag Blog / February 16, 2009

[Stayin' Alive is a periodic column on Complementary and Alternative Medicine by Rag Blogger Mariann G. Wizard, a professional science writer with a wide-ranging knowledge of natural health therapies. Readers may suggest topics for future columns; use the Comments section below the article.]

In establishing a self-health care continuum that successfully incorporates both conventional Western medicine (CWM) and complementary and alternative medicine (CAM) elements, the best tool would be a solid understanding of how our own bodies work. Many people believe that they possess such knowledge; many more believe that even if they don't, their health care provider (HCP) does, or that Medical Science in general must have the facts.

"Nuts!" to all that.

To the contrary, I would venture to say, for example, that most folks' understanding of their digestive system resembles the indigestion remedy ads of the 1950s: a hole at each end, a long tube connecting them, and a holding tank, or "tummy," nestled cozily in the middle, where mysterious fluids ebb and flow.

As far as imagining that your HCP has a much better understanding, that is also a dubious assumption. HCPs are highly educated and well-informed about many things, but the how and why of healthy functioning aren't much stressed in their education; it's more about how to respond to the illnesses and dysfunctions we all-too-frequently sprout.

As for Medical Science, sometimes it must seem to the attentive reader that we are still living in the Middle Ages, if not Middle Earth! Many amazing things may be seen and "proven" in laboratory (in vitro) studies, where everything happens in a test tube or Petri dish.

In screening labs all over the world, substances are tested for antibiotic, anti-inflammatory, and/or anti-cancer effects, among other actions. Many hundreds of natural substances, most from plants, exert such effects in vitro. Among them, as one small example, rosmarinic acid, from the common herb rosemary, has very potent antibiotic effects in vitro.

However, this has not yet translated into an effective antibiotic medicine.

Similarly, animal tests (in vivo) may illuminate many biologically active substances; however, they are unreliable predictors of how a substance will act on humans. Rodents and rabbits, used in the great majority of in vivo studies, have substantially different physiological systems than humans. The only animals, really, that are close enough to human beings to make in vivo studies reliably predictive of a chemical's effects on us are other primates: chimpanzees, orangutans, monkeys, etc.

We have no compunction, as a species, about sacrificing hundreds of thousands of rats and rabbits annually in the name of Science, even breeding special research animals who are born with or develop specific disease conditions, e.g., cancer.

Primates, fortunately for them, do not reproduce quickly enough, or in sufficient numbers, to make similar research on them cost-effective, and we may stroke our "humanitarian" side as Masters of Nature, with strict controls on primate medical research, requirements for "humane" treatment, and laws limiting trafficking in their lives, although these latter seem, from preservationists' reports, to be rather loosely observed in some areas.

The essential irrelevance of animal research to advance Medical Science as applied to humans is probably the strongest argument against such research. A cancer drug that "works" in mice doesn't necessarily produce the same effects in human beings.

Human clinical research is much more strictly limited, with international protocols and standards of informed consent, exclusion of subjects with certain risk factors, and the option to drop out if a trial medication produces unacceptable adverse effects. Randomized, placebo-controlled human trials (RCTs), the "gold standard" of clinical research that can lead, in the U.S. and in many other countries, to official approval of a new medication, are thus extremely expensive and, as has been pointed out in previous columns, are generally only conducted by pharmaceutical companies seeking approval for a single, newly-synthesized chemical compound for use in a specific condition or conditions.

More and more, as our frontiers of knowledge expand, researchers are better able to see the great unknown in which they operate. Within the human body, thousands of compounds are created, used, activated and de-activated, altered, broken down and disposed of, all without our conscious volition. We are, each of us, amazing biochemical factories. Responses throughout our bodies occur in linked but mutable ways, often involving "cascades" of reactions, like a string of black-cats popping on the 4th of July.

In the U.S., pharmaceutical companies seeking drug approval provide evidence of effectiveness and safety that meets Food and Drug Administration (FDA) standards. And, while there are hundreds of ways to design RCTs, hundreds of different "outcomes" that may be measured, and hundreds of ways to statistically analyze the results, there is no agency blueprint for constructing a study design that would or could apply in every case.

Nor is there any true national or international agenda for research, in terms of priority diseases to combat, or studies that should be conducted. It is all done on a somewhat laissez-faire basis, with scientists trying to research along their own interests, and funders defining those interests with dollars.

By the time Medical Science gets down to the level of a busy CWM practitioner, it is usually in the form of a pharmaceutical company salesman with new drug samples, or a Physicians' Desk Reference (PDR), with information on every approved drug available, its indications, dosage, and known adverse effects or contraindications.

By the time it gets down to us, the Patient, it's an advertisement for a new product that promises relief of what ails us; how it works is often the least of our concerns. We simply assume that somebody knows, and take our medicine.

Unfortunately, knowing how a compound behaves toward disease organisms, for example, doesn't necessarily convey how it behaves toward healthy tissue, or what other effects it may exert over time. The periodic recall of formerly-FDA-approved drugs that have been found, sometimes years later, to cause unacceptable "side effects" is a constant reminder of the huge void in which Medical Science is still but a flickering candle throwing shadows on the walls.

Women's health

Our slow climb from ignorance to knowledge has hardly been uninterrupted. In 1973, Our Bodies, Ourselves: A Book by and for Women (Boston Women's Health Book Collective) showed women of all ages with photographs and accurate diagrams of their own intimate body parts and instructions for self-examination that had previously been available, without the straightforward text, only in the rawest men's sex mags.

[Austin bookseller Susan Post (Book Woman, 5501 N. Lamar, Austin) recommends Our Bodies, Ourselves as a great high school graduation gift. Newer companion volumes cover girls' and teens' health issues, pregnancy and childbirth, and menopause.]

For many generations "Nice girls" were strongly discouraged from curiosity about what they looked like "down there," how the female organs functioned (other than to regularly "bleed"), and, certainly, from knowing how to self-identify and treat common conditions like yeast or urinary tract infections. Breast self-exams? We weren't supposed to play with the melons, either, especially not rubbing them firmly with soap-slippery fingers in rapid concentric circles!

Yet at one time, worldwide, women were primary keepers of much medical knowledge: herbalists, midwives, wetnurses, gardeners, cooks, preparers of the dead. Man, perhaps because of his interests in hunting and herding, seems historically to have gravitated more towards dentistry, surgery, and bonesetting. However, much herbal knowledge, and common remedies, are shared by both sexes in almost every "primitive" society.

"Witches," or traditional healers, both female and male, have been persecuted particularly since the rise of Christianity, and continue to be persecuted in Africa today, but what Friedrich Engels called the "world historical defeat of matriarchy" happened long before Jesus' birth. We won't go into all that now; it's too long and sad a tale.

As a result of "all that," however, health issues specific to women have often been relegated to second-class status in CWM. Even today, women are under-represented in clinical trials, and even in some population-based (epidemiological) studies that track broad health trends.

For example, there are epidemiological studies showing that Asian men who adopt a Western-style diet, both in Asia and in the West, tend to develop Western-style cardiovascular and other problems at a higher rate than those who eat a traditional Asian diet, but little research has asked if the same trend exists in women.

And, while heart disease is the number-one killer of men and women worldwide, it is much more studied in men than in women. Only recently has it been recognized that women's heart attack symptoms differ substantially from men's, and that many women's heart attacks are not recognized as such.

CAM research is a little better. Herbalists frankly acknowledge their debt to "wise women" of past eras. But ethnomedical researchers, seeking new therapeutic compounds and/or practices, tend to focus on interviews and field expeditions with traditional male healers. Unless a female healer is especially renowned, her knowledge is likely to be relegated to the dustbin of "folk or household remedy."

Some CAM clinical studies, as in CWM, focus on men alone. Of course, there are legitimate reasons for this in some cases -- for example, in studying benign prostate hyperplasia (BPH), women participants would have little to contribute -- but clinical knowledge tends to build up, over time, more knowledge of men's health.

However, modern pharmaceutical companies and medical specialists have taken to heart women's quest for health, and a growing number of products and services are targeted to women consumers. Dear Sisters, please keep in mind that, just because a product's ads imply that the entire company is founded on love and respect for women, features pink bows, and contributions to women's health research, that doesn't necessarily mean it does what it says, or only what it says. Don't be conned by a cute, savvy marketing campaign.

On a more positive note, a growing body of research shows that the health of any community's female members is a strong predictor of the health of all. Healthy women tend to produce healthy children and nurture healthy men, boys, and girls.

How others see it

By now, some of my readers are surely bubbling over with vexation at my debunking the infallibility of CWM. "At least," they may be thinking, "Western science has identified all of the human organs, unlike nonsensical psuedo-systems such as traditional Chinese medicine (TCM)!"

I have to admit, when I first began reading articles on TCM for Austin's American Botanical Council, I was quite flabbergasted by some of the concepts it involves. The most difficult to swallow was TCM's apparent ignorance of the stomach and other organs in favor of an "upper burner," "middle burner," "lower burner," etc. I mean, even if the study of anatomy never got around to dissection, any meat-eating society ought to be able to identify a mammal's "liver and lights," right?

My bafflement came from looking at TCM with CWM-educated eyes. TCM is, first and foremost, a philosophy of health, in which structure is less important than function, and "balance" between and among an infinite variety of biological events and processes is the essence of health.

In my own crude way, I've come to see TCM's upper burner "organ" as corresponding to the oxygen/carbon dioxide cycle of CWM's heart, lungs, and circulatory system; the "middle burner" as corresponding to digestion and extraction of nutrients in CWM's stomach and small intestine; and the "lower burner" as corresponding to the waste removal functions of CWM's large intestine, kidneys, bladder, etc. I'm probably wrong in the specifics of my grasp. But I'm convinced I'm on the right path!

It's somewhat analogous, I think, to being able to identify and/or trouble-shoot a carburetor, and being able to identify and/or trouble-shoot an internal-combustion engine. One may lead you to the other, but the other will never lead you to the One!

The tendency to focus on one aspect or effect -- to look at one tree instead of the forest -- may be the main weakness of CWM as a system of medicine. Laboratory research and RCTs tend to illuminate only a few of what may be many variable effects of a medication. Single-molecule medicines are the standard, with the thousands of molecules present in any herbal remedy, for example, being perceived as potentially problematic rather than potentially synergistic or balancing.

Literally thousands of standard multi-herb formulas are recognized in TCM and in other CAM systems such as India's traditional Ayurveda (one of several recognized systems of medicine on the subcontinent). These routinely contain at least three different herbs; many boast a dozen or more. Analyzing their effects scientifically presents major challenges, although both China and India are strongly committed to such research, in the hope that some traditional formulas may reward those who can obtain approval for their use on a prescription basis.

Frankly, I can't help but think that the profusion of multi-herb formulas must challenge TCM practitioners as well. Success demands that they be able to see both the forest of possibilities and the individual "tree" presenting with pain or other symptoms; then to select, and in many cases personalize, the formula that will be most helpful in restoring systemic balance. Tell you what, we'll see if any practitioners of this fine art can explain it for a future column, OK?

Whoooooo are we? Who, who, who, whooo??

As human beings, most particularly in the West, we learn to see ourselves as unique individuals; each of us a perfect snowflake in the blizzard of life. When we get sick, we become even more determinedly individualistic, each of us asking, "Why me?" Yet there is more and more evidence that our question should be, "Why us?"

For every cell in what you think of as your body, you contain, or carry, ten (10) single-celled organisms: bacteria, fungi, and whatever else is out there in the unicellular universe. And the majority of these are not invaders, parasites, or attackers, but symbiotic organisms without which you could not live, or would experience a far inferior quality of life. (I'll admit to wondering if that 1:10 ratio is somehow related to the reported "fact" that we use only 10% of our brains. Are our symbiotes using the other 90%??? Goddess, I hope so!)

Really, everybody should know by now about the symbiotic organisms that live in our digestive tracts, performing functions that our bodies cannot perform without their presence. Yet we abuse these little critters unmercifully, eating foods that don't nourish them, and periodically dosing them with killer chemicals – ANTI-BIOTICS, get it??

After any course of antibiotics, it is both wise and kind to restore one's natural microflora balance with a course of probiotics. Why aren't these routinely recommended or even prescribed at the same time antibiotics prescriptions are written? Why doesn't the pharmacist counsel us to ingest probiotics after the antibiotics are done? The simplest way to support your gut symbiotes is to eat yogurt, and/or other fermented foods with active cultures.

Besides our gut, the skin, our largest organ, is next-most-populated with micro-critters. This was brought home to me forcefully and embarrassingly last summer, when a persistent butt-oriented rash defied a round dozen over-the counter and CAM products, prescribed antibiotics and antifungals, the services of five HCPs, recommended soaps and cleansers, sitz baths, antihistamines, and a recommended herbal tea, and led your humble health writer to the brink of despair; yea, to the brink of triggering her high-deductible health insurance!

Robert W. Cline, M.D., of Central Texas Colon and Rectal Surgeons, in the nicest way imaginable, finally clued me that cleanliness is not next to godliness where the sun don't shine. I had, you see, been using flushable moist wipes -- I told you it was embarrassing! -- and was killing off beneficial microflora that are vital to keeping the skin of rectum, anus, and adjoining areas proof against harmful organisms, to which they are routinely exposed in doing their duty.

The wipes I used contained vitamin E and aloe vera – two natural skin protectors – and I'd been using them for quite some time before problems developed, so it didn't occur to me that I was causing the rash. By depleting my skin's natural oils, I was depriving my microflora of their habitat. Three days after I stopped using the moist wipes, I could sit down again!

According to Dr. Cline's "butt lecture," the cure for 95% of pruritis ani (itchy anus) -- is to stop overzealous cleaning. Wash with warm water and pat dry; that's all ya need.

One problem with this sort of experience is that any number of the remedies I tried may have been sufficient to treat the various infections and what-not I may or may not have had, but I kept on ignorantly repeating the underlying, undiagnosed cause, so none of them had a chance to work.

So, whattaya gonna do?

So, given that human health, disease prevention, and treatment, regardless of which system of medicine one chooses, are full of unanswered questions and unsolved mysteries, how is an average, non-medically educated person supposed to take care of him-or-herself?

First and foremost, know what it feels like to feel your best, and be aware of your own health practices. If you are accustomed to eating whatever you like, and begin to notice frequent indigestion or an unwanted change in your weight, start keeping a detailed food diary, writing down every single thing you eat and any symptoms you experience.

Stay away from foods you suspect may be disagreeing with you and see if symptoms clear up. Allergies to wheat, gluten, milk products, eggs, and other foods may emerge at any age. The very act of keeping a food diary has been found to improve weight control.

On the other hand -- and there is always an "other hand" -- be aware of what nutrients you may be giving up if you delete a certain food from your diet, and take care to replace it with other foods or supplements. I have what is these days called a lactose intolerance -- in my opinion, adult mammals are not meant to drink milk as a beverage! -- so I'm careful to get calcium and vitamin D from other sources.

Do you feel less energy than you think you should? Have more insomnia? Unless symptoms arise suddenly or involve pain, I would try to observe and be conscious of possible causes for a couple of weeks, anyway, before visiting a HCP.

Stress -- unrelieved activation of a biological response -- depletes energy, yet can also cause sleeplessness. Stress contributes to many common illnesses, including heart disease, irritable bowel syndrome, depression, and, probably, cancer. Increasing pleasurable physical activity, getting a therapeutic massage, or giving yourself a long, pampered week-end of rest and wellness can make a strong positive contribution to restoring overall health.

Be aware when stress, changeable weather, air-borne allergens, or other conditions may tax your immune system. I've found in recent years that a few cups of tasty echinacea tea, sweetened with honey or agave nectar, really bolster my immune system in cold and flu season.

If a couple of weeks of solid rest, healthy eating, and adequate exercise don't make a difference in your feelings of well-being, consider having a complete physical exam. Whether by a general practitioner (GP), TCM doctor, naturopath, or other qualified HCP, a complete exam should measure baseline parameters and health status, and identify areas of concern. And we'll talk more about getting one in yet another future column!

For now, take good care of yourselves!

Image from aussie claus.
Self-health tip:
Miracle cures and fads don't work

Human beings are funny. We have rational minds, but often ignore what our minds know in favor of what our emotions (or our symbiotes???) desire.

In health care, if it sounds too good to be true, it probably is.

Americans spend millions every year on diet fads, in a vain attempt to shed pounds. Currently, there is only one FDA-approved product for weight loss. It is quite costly, and not reimbursed by insurance plans.

The only proven way to lose weight, and to keep off excess weight, is to consume fewer calories than are expended in activity. Even the new over-the-counter pharmaceutical operates on this principle, preventing digestive absorption of some fat calories.

"Miracle cures" are touted for diabetes, arthritis, cardiovascular complaints, and about every ailment known to mankind, and have been for thousands of years. In general, it's best to keep in mind that someone who is trying to sell you a product is not the most objective source of information on that product's efficacy. (To me, a real "miracle cure" would be one without a price tag!)

This same philosophy can be applied to the hoped-for miracle of "health care reform" in the U.S.! There is no quick cure for what ails us. The only way to reduce health care costs, and to keep them down, is to consume fewer acute health care services, preventing serious problems through positive practices.

As the population ages -- over 22,000 Americans are now over 100 years of age, with the number increasing every year -- preventive health care will become more and more vital to prevent a break-down of the health care system. If we're going to live to see 100, don't we want to be healthy as long as possible?

The biggest thing fueling the popularity of "miracle cures," as well as of proven CAM treatments, is CWM's lack of success in treating chronic illnesses and disorders. Fact-based research into what works and why could begin to show a way out of the maze of competing claims, but when almost all medical research is funded by pharmaceutical manufacturers, is it any wonder that our most popular medical fads all seem to involve a novel synthetic pill?

As for dietary supplements, there is not any one vitamin, mineral, or herb that can cure the hundreds of conditions for which claims are implied by unscrupulous internet marketers. As we can and really should learn from TCM, Ayurveda, and other non-Western health system, true health rests on balance, and over-reliance on any one substance simply isn't healthy.

-- mgw
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