Health and Healthcare

Health is defined by Websters dictionary as; “physical and mental well being; soundness; freedom from defect and pain of disease; normality of mental and physical functions. Health is something different from strength; it is a universal good condition”. The World Health organization defines health as follows; “Health is a state of complete physical, mental and social well being and not merely the absence of of disease or infirmity”.43 If we look at the WHO definition which states that health is more than the absence of disease, the question becomes, how in our present medical paradigm do we determine the state of ones health. The answer to this question exposes the reality that the present system allows only for the determination of diagnosable states of disease. The term “Preventive Medicine” is part of our current medical lexicon and when physicians speak about so called preventive care, they refer to the implementation of certain medical procedures. These procedures are colonoscopies, mammograms, PSA tests, cardiac stress tests and the like. The reality is that, at best, these tests allow for “early detection” of existing disease states which could afford the opportunity for intervention to produce a better outcome. What do they actually prevent? Nothing! They make possible, interventions that could be life saving but they are not prevention in the truest sense.

If we refer once again to our Healthline which represents the reality of a continuum between death and optimal health, we can designate an arbitrary point on the line and make this point the position at which the diagnosis of a degenerative disease can be documented. (see Figure 2 below) If we arbitrarily take another point on the line placed closer to optimal health and designate this as being a month before the point at which a diagnosis was possible, can we then say that at this time, this person was in a state of good health? Understanding the biological reality that molecular and cellular degenerative pathologies develop slowly over long periods of time, often many years, we must conclude that this person was in poor health and in a state of imminent pre-diagnosis. We can also agree that if chronic degenerative diseases take years in their development, involving slowly progressive molecular pathologies that are common to all these diseases, that we can view this picture as a significant window of opportunity!

Figure 2

In fact the window of opportunity can be seen to be very large and dependent upon how early in the development of degenerative pathology intervention is begun. What is required is the ability to assess where one lies on the Healthline and the ability to provide interventional strategies that can improve that position by moving one closer to the position of optimal health. True healthcare must involve treatment strategies that are provided before a disease can be diagnosed. This is what real prevention is!

This goal can only be accomplished if we have the tools to properly assess the state of ones health and the tools to intervene in a manner that would produce true health enhancement. The fact is that the last 20 years have provided us with these necessary tools. The prestigious Institute of Medicine recently published a report that estimates that only about half of what doctors do today is backed up by valid scientific evidence. The rest are tests and procedures that are based in medical tradition or on unproven and potentially faulty assumptions about how the body works.68 We must educate the medical community first and then call upon their better angels to help in the struggle to move the economic and political forces in the direction of real healthcare.

How to Assess Health

To determine the position on the healthline continuum of an individual with no diagnosable disease requires an entirely different constellation of biomarkers than are currently used in routine blood profiles. The routine blood profile consists of markers for liver and kidney function, a cursory lipid profile, blood sugar and several electrolyte levels along with a complete blood count for white and red blood cells. The so called “normal” reference levels usually fall within a wide range and little distinction is made regarding whether one is at the lowest or highest level within this normal range. The actual ranges have been determined by sampling large numbers of so called “healthy” people and establishing a range within which 95% of this population falls. The problem is that “healthy” in this situation simply indicates no apparent disease state, but as we have seen, the absence of disease does not signify that one is healthy, so we have no way of knowing what really is normal and certainly no way of knowing what might be optimal. The other issues with this routine blood profile is that abnormal levels are indicative of already developed end stage disease, as with abnormal liver or kidney function tests. The lipid profile which includes a total cholesterol level along with HDL and LDL totals and triglycerides is grossly inadequate for assessing cardiovascular risk, as there are at least a handfull of documented risk factors which are not included in routine testing.

For a more accurate assessment of the state of ones health we need a different set of biomarkers that will assay our molecular biology and allow us to view the functional state of ones personal biochemistry at its most basic level. This will afford the opportunity to provide pre diagnosis treatment strategies that will reduce ones risk for all degenerative diseases and move one further towards optimal on the healthline. There is a caveat that must be included at this point. In order for screening tests to be useful, they must be readily available, accurate, be inexpensive, pose little risk and cause little discomfort to the patient. The tests that will be described here are accurate, pose no risk and afford little discomfort,however they are not readily available and are not inexpensive. It then becomes the task of the political and economic forces in the healthcare industry to reduce these costs and make them more readily available. This is not an inconsiderable problem and will require public pressure and the political will to do what is in the best interests of the health of the American people.

Biomarkers for Medicine; A Sampling of Tests Done Academic and Specialized Commercial Laboratories

A- Biomarkers for Common Factors of Chronic Degenerative Diseases

Oxidative Stress

Oxidative stress occurs when the generation of (ROS) Reactive Oxygen species in a system exceeds the systems ability to neutralize and eliminate them. This occurs because of an overabundance of ROS or a lack of anti-oxidant capacity. Several tests are as follows:

• MDA: (Malondialdehyde) assays... .Using ELISA or Western Blot methods, more accurate than the traditional TBARS. This measures the extent of lipid peroxidation.44
• F2- Isoprostanes: newer more reliable measure of oxidative stress. F2-Isoprostane group consists of a series of prostaglaudin F2 compounds generated by the peroxidation of arachodonic acid. Can be measured in blood serum, plasma or urine.45, 46
• 8-OHdG: DNA is the most biologically significant target for oxidative damage. Oxidation of guanosine from DNA base rings produces 8- OHdG (8-hydroxy-2- deoxyguanosine). Elevated levels of 8-OHdG indicate DNA damage and need for greater anti-oxidant capacity.47

Inflammation

Chronic inflammation involves many complex signaling pathways which evoke a host of cellular and systemic responses. Mediators of these pathways include hormones such as adrenaline and cortisol and pro inflammatory cytokines such as TNF-a (Tumor necrosis factor alpha) 1L-6 (Interteukin-6) , IL-l B (Interleukin-lB and Interleukin-8 (IL-8).

• CrP: C- reactive Protein has been the accepted test for the measure of systemic inflammation. A newer, more sensitive test, called cardio CrP which can detect much smaller increments has become the benchmark for assessing heart disease risk related to inflammation.48
• MPO & IL-6: MPO (myeloperoxidase) is a protein made by white blood cells that has been shown, along with IL-6 to be a better predictor of cardiac events than the standard risk factors.49
• Cytokine panel: To include IL-6, IL-lB, IL-8 and TNF-a 50

It should be noted that elevated levels of CrP and 1L-6 are predictive of type 2 diabetes as well as increased risk of all cause death.

Glycation

• HbA1-c: (Glycohemoglobin) is the standard test for glycation. It measures the level of glycated hemoglobin in the red blood cell. This indicates the status of glucose management over a 3 month period. It is used to monitor progress of treatment in Diabetics and has been shown to have a linear correlation with risk of heart disease.51

• Glyceraldehyde-derived AGE’S: This can be done on blood serum and has been shown to be a biomarker for Alzheimers disease. Glycation of senile plaques of amyloid beta accelerate their progression.52

Methylation

• Homocysteine: is the standard test to evaluate methylation capacity. If methylation is defective then levels of homocysteine increase and this represents a major risk factor for many degenerative diseases.53 Methylation defects in the DNA of the cell nucleus play a key role in tumorogenesis.54

B- Biomarkers for Endogenous Anti-Oxidant Systems

Glutathione (GSH): “The Master Anti-oxidant” 55 Glutathione is present in virtually every cell in the body and is the major intracellular endogenous anti-oxidant. It recycles vitamin C and other anti-oxidants and itself scavenges the peroxide radical. Glutathione peroxidase is a selenium based peroxidase which converts hydrogen peroxide to oxygen and water. It is measured in the blood. Glutathione reductase is the enzyme which catalyzes the oxidized glutathione back to its reduced active form.

Super Oxide Dismutase (SOD): SOD is one of the most important antioxidant systems that mops up free radicals. It scavenges the dangerous superoxide radical, converting it to hydrogen peroxide. There are 3 different forms of SOD, type 1 which is located in the cytoplasm of the cell and is copper and zinc dependent. Type 2 is located in the mitochondria and is manganese dependent and type 3 which is located extracellularly and is copper and zinc dependent.56 Levels can be determined through blood testing.57

Catalase: Catalase is the third endogenous anti-oxidant enzyme that catalyzes the decomposition of hydrogen peroxide to water and oxygen. Accumulation of hydrogen peroxide can result in cellular damage through oxidation of proteins, DNA and fats, all of which contribute to the development of chronic degenerative disease. Blood screening techniques are available.58, 59

Fatty Acid Analysis

Fatty acid balance is a critical element in affecting overall health. It is completely ignored by the existing “usual and customary” medical interventions. Improper fatty acid balance, which is very common in western diets, can have a major impact on the level of chronic inflammation. Fatty acid levels affect the balance of anti and pro inflammatory substances such as prostaglandins, leukotrines and thromboxanes. In typical American diets there is often a significant imbalance weighted towards overconsumption of omega 6 oils and underconsumption of omega 3 oils. If one is taking in large quantities of these polyunsaturated fatty acids without adequate anti oxidant protection, the result can be dangerous lipid peroxidation. It is also possible, in the rare instance where there is overconsumpttion of omega 3 acids, that these anti inflammatory effects can actually suppress immune function. These fatty acids are incorporated into the structure of all cell membranes and the stability and balance of lipids in these membranes determine what is allowed to enter as well as leave the cell. Since we know that the health of the cell ultimately determines the health of the organism, we can appreciate the importance of achieving proper fatty acid balance.

Metametrix Lab. offers a comprehensive fatty acid panel using plasma analysis. This panel includes levels of all omega-3 acids, all omega -6’s, omega- 9’s, monounsaturates, saturated acids and trans-fats.60

Hormones and Neurotransmitters

Hormones are chemicals that serve as one of the many ways that cells communicate with each other. There are more than a hundred hormones but the ones of major concern are estrogen, progesterone, testosterone, thyroid, cortisol, DHEA, melatonin and insulin. Hormone levels decline with age and this decline has been implicated in the development of chronic degenerative diseases. Neurotransmitters, like hormones, are chemical messengers both in the brain and the body. They are the means by which nerve cells communicate with each other. There are two classes of neurotransmitters, the amino acids; glutamate, aspartate, gaba amino butyric acid and glycine and the second group which are the biogenic amines; acetylcholine, serotonin, and the catechol amines, epinephrine, nor epinephiine and dopamine. Research has established s definite link between deficient or excessive levels of neurotransmitters and chronic degenerative disease.61 Hormone panel test: to include DHEA, thyroid, testerone, free testosterone, estrogen, cortisol and insulin levels.50 Neurotransmitter Profiles done by urine testing 62

Heavy Metal Testing

Heavy metal toxicity is related to the increasing levels of pollution in our environment finding its way into air, water and food as well as household products. Depending on the tissues in the body in which they concentrate, heavy metals are capable of producing a variety of symptoms which usually go undiagnosed because physicians do not often test for heavy metals. The most common culprits in this venue are, arsenic, cadmium, lead, iron and though it is technically not a heavy metal, aluminum, which is ubiquitous in our society. Metals can also upset the balance of mineral levels in the body. There are methods available for their removal. Test: Heavy Metal Blood Panel50

Minerals

Linus Pauling once said,”You can trace every sickness, every disease and every ailment to a mineral deficiency.” 63 Minerals are extremely important factors in ones health. They serve as enzyme co-factors in most of the chemical reactions that comprise our metabolism. Minerals are essential components of nucleoproteins, mettaloproteins, nucleic acids, nucleotides (ATP), lipoproteins, and enzymes. Routine blood tests check levels of calcium, potassium, sodium, phosphorus and iron. We should also test for magnesium, copper, zinc, manganese, selenium and chromium.

Additions to Routine Blood Profile

To better assess risk factors for heart disease the routine blood profile needs to include documented independent risk factors that have yet to become routine in part because they are not yet covered by insurance. (The Latency period). Free testosterone, homocysteine and CrP are independent risk factors that are included in the Life Extension hormone panel.50 LDL Particle size and density and Lpa are included in the VAP test which is an expanded lipid profile.50 If these tests are not included for you, then they should be added to the routine blood profile As the drug commercials on TV say, “ask your Doctor about...”. The other heart disease risk factor that should be tested is fibrinogen. An additional test that should be included in routine blood testing is your Vitamin D level beause deficiency states have been implicated as risk factors for many degenerative diseases.142