by Derrick Lonsdale, MD
The present concept involving disease is to "make a diagnosis". The specific disease is then named in much the same way as we might use in collecting alpine flowers or stamps. It is recognized by a constellation of symptoms and signs and the "proof" is believed to come from the laboratory. If there is overlap between several diseases we go about making a "differential diagnosis", perhaps the best example being collagen diseases. The only trouble with this is that Mother Nature does not understand our classification and did not construct the model by which we diagnose. This is not the only error in our thinking. With the exception of antibiotics designed to "kill the enemy", we try to find a "cure" for each and every disease as it is described. We now have a fantastic array of potentially poisonous substances that are so numerous that they have to be catalogued in the Physicians Desk Reference, a tome that almost exceeds the dimensions of a volume of Encyclopedia Brittanica. Even with the acknowledged concept of antibiotics we have come to recognize their limitations and dangers. Louis Pasteur, on his death bed, said "I was wrong: it is the terrain that matters". He had recognized that the body could only exist in a hostile environment by initiating a defensive strategy that is an innate part of our evolution. So is an entirely new model required? Should we be content with merely treating symptoms?
Turn for a moment to considering the mechanisms of survival. We adapt to ambient temperature changes, to the day/night cycle through circadian rhythm, to mental and physical stress by means of the sympathetically activated fight-or-flight reflex, controlled by the hypothalamic autonomic endocrine axis. Panic attacks, that affect thousands, are fragmented fight-or-flight reflexes and I have seen many patients that cannot adjust to ambient temperature changes. They feel hot when the temperature is cool and shiver when it is warm. The limbic system, where emotional reflexes are initiated, is clearly a computer.
I remember a child who had gone swimming in warm water on a very hot day. He came out of the water with blue lips and shivering with cold. It took two hours to reverse these symptoms by wrapping him up in a blanket. He improved drastically by correcting his junk based diet. There is a disease known as Ondine's Curse where these automatic mechanisms fail and death occurs because automatic respiration ceases. The name comes from a mythological character called Ondine. She was a water nymph who fell in love with a mortal male who jilted her. She cursed him by abolishing all automatic brain function. He had to remember to control all the muscles and organs that had been controlled automatically before. He had to remain awake in order to breathe. Eventually he became tired and went to sleep so he died because breathing stopped. It is virtually certain that this myth arose from observing this kind of mysterious death. The brain is reported to use 20% of the oxygen inhaled with each breath and it is known to die very quickly if oxygen deprivation exists for mere seconds. Sometimes we forget that oxygen is the primary nutrient since oxidation synthesizes ATP. The best analogy that we have for the human brain/body is a computerized system that takes care of everything that enables our survival, so consider the following simple equation:
Fuel + Oxygen + Catalyst = Energy
Abnormality of the control mechanisms in the limbic system and brainstem results in dysautonomia, a fact that is shown most clearly by considering the pathology of beriberi. In its early stages it is the prototype for dysautonomic function. In its later stages the autonomic ganglia degenerate and the disease is irreversible (1). It is now very well known that the disease results from a high ratio of carbohydrate calories to the B vitamins needed to oxidize them. Thiamin is probably the rate limiting factor so it is more implicated than the other B vitamins.
Oxidative metabolism applies to every cell in the brain/body complex but it is to be expected that if it is inefficient it would be likely to affect the tissues that are most dependent on oxygen. That is the reason that beriberi has its well known effects in the brain, the autonomic nervous system and the heart. A search of the literature showed that there have been innumerable reports of organic diseases being associated with dysautonomia. Each report states that a major organic disease, for example bronchogenic carcinoma in one case, was associated with dysautonomia. The combination remained a mystery for each author and was said to be case reported because of the unusual nature of the presentation of two diseases in one patient at the same time. From that we can extrapolate that the dysautonomia probably preceded the organic disease because that is where oxidative loss of efficiency started. Either because the communication between the "brain computer" and the organ failed, or because continued oxidative inefficiency affected one or more body organs later, the underlying pathology can be seen to be connected (2). Perhaps the secret of disease in general is the complex mechanisms that surround redox potential and that a new model for disease should be based on biochemistry and not on symptoms that can be seen as "alarm bells ringing in a complex system".
Dysautonomia is generally thought to be genetically determined as in Familial Dysautonomia that afflicts Ashkenazic Jews (3). Sir Roger Bannister edited the most definitive book on the subject (4). No mention of malnutrition appears in the book and beriberi is not quoted as an example. In the present disease model, a patient complains of the primary symptom and does not volunteer many other symptoms that are thought by the patient to be relatively trivial or even normal. If a questionnaire that asks specific questions is provided to the patient prior to consultation, it will be found that there are almost invariably a whole series of symptoms that have not been volunteered.
Perhaps an example might be the question "Do you become dizzy or light headed when you stand up from sitting in a chair or getting out of bed?" If the answer is positive, it is evidence of postural hypotension, a cardinal symptom of dysautonomia. A positive answer is surprisingly common and is sometimes associated with blacking out, sitting down for a few moments, or hanging onto furniture. Panic attacks are extremely common and are frequently not volunteered because of a sense of shame.
It has already been published that dysautonomia is an essential part of the pathology of autistic spectrum disorder (5). The parasympathetic system depends on cholinergic metabolism derived from processing glucose through the citric acid cycle. Because the authors found this system to be weakened, autonomic reflexes are dominated by the sympathetic branch of the system. This was illustrated by the case of a child with autism that received an injection of secretin (6). The father had noticed that his child had widely dilated pupils that did not react even to sunlight. On the day following the secretin his pupils began to react normally. Since there are receptors for secretin in the hippocampus, we can conclude that the secretin stimulated more normal activity of the parasympathetic outflow.
The widespread ingestion of sweet sugary foods in America results in high carbohydrate calorie malnutrition. This results in stressing entry of glucose into the citric acid cycle that depends so heavily on an adequate supply of B vitamins, especially thiamin (7). The evidence points to the fact that this causes loss of efficiency in oxidative metabolism that affects brain function first. In its early stages it causes hyperactive limbic system reflexes that make the person much more emotional. A reprimanded youth, instead of reacting in a controlled manner, kicks the door or wall. I remember a youth that dove through a plate glass window, cutting himself badly in the process. His diet was typical of a vast segment of American youth. Can vandalism or even adolescent crime be ascribed to high calorie malnutrition in many cases? Can hot crime be differentiated from cold blooded malice aforethought? Perhaps the underlying problem of health and disease is that we cannot live without oxygen but it "gets us in the end". Our cars rust out and so do we except that the "rust" represents oxidative destruction in a different way
REFERENCES
1. Inouye K, Katsura E. Etiology and pathology of beriberi. In:Thiamine and Beriberi. Igaku Shoin Ltd. Tokyo;1965:1-28
2. Lonsdale D. A heuristic approach to a revised model for etiology of disease. Evidence Based Complementary Alternative Medicine 2009;6:3-10
3. Riley C M, Moore R H. Familial dysautonomia differentiated from related disorders Pediast 1966;37:435-446.
4. Bannister R. Autonomic Failure. Oxford, Walton Street, Oxford Univ Press OX2 6DP 1984, 1-666.
5. Ming X, Julu P O O, Brimacombe M, et al. Reduced parasympathetic activity in children with autism Brain Dev-Jpn 2005;27:509-516.
6. Lonsdale D, Shamberger R J. A clinical study of secretin in autism and pervasive developmental delay. J Nutr Environ Med 2000;10:271-2870
7. Lonsdale D. A review of the biochemistry, metabolilsm and clinical benefits of thiamin(e) and its derivatives. Evidence Based Complementary Alternative Med 2000;10:271-280.
Posted: 03/25/2010
