Author: lawrencecheng

Healthy Immunity Part One

Part One:  An Integrative perspective of Healthy Immunity

The function of the immune system to protect the organism from potential threats.  These threats can be external infectious agents such as pathogenic bacteria, viruses, other micro-organisms but also include environmental toxins and chemicals.  The immune system also provides a surveillance function to keep in check any cells replicating out of control which could lead to cancer and also helps to remove damaged cells that no longer function properly.   The immune system has a complicated  task of continually needing to evaluate whether a given molecule out of thousands of different molecular shapes is truly a threat or not. This speaks to the need for discernment on all levels – molecular to whole person.

The immune system needs to be sensitive, detective and defensive but also needs to know when to be tolerant of its own self tissues.  Healthy immunity is an internally regulated, balanced system that responds appropriately to the level of threat.  A deficient immune system will not be able to defend against an infection but on the other side, an excessive immune response can lead to allergy as well as an attack on own tissue (autoimmunity).

Immune responses need to be tightly controlled and actively resolved.  If not, an initially adaptive acute inflammatory (healing) response can turn into a chronic inflammatory response which causes tissue damage and can lead to disease. This leads to the strategy of decreasing the total inflammatory load on the body to allow the mechanisms of self-regulation to function properly.

The state of readiness and balance of one’s own immune system at a given point in time is a function of many factors which span through someone’s entire life-course.  Early factors including mode of delivery (C-section vs normal vaginal birth), breastfeeding, early antibiotic exposures, food and toxins can have significant effects on a child’s microbiome which appears to be involved with immune system programming and tolerance.

There exists a significant body of  research which has connected imbalances in gut microbiome, gut mucosal inflammation and increased intestinal permeability with an increased risk of immune dysregulation.  These imbalances may be the result of foods that can cause inflammation as well as on-going exposure of environmental toxins, chemicals, pathogens and possibly increased psychological/emotional stress.  The gut contains a large amount of our immune system cells.  This makes sense as out gut represents a large surface area in contact with the “outside” world.  This is our border, our interface which must be defended.  This is why gut health is a major key to healthy immunity.  This topic will be explored in further posts.

Healthy immunity is also restorative.  The immune helps to repair damaged tissues that results from injury or adversarial encounters.

Healthy immunity is tolerant. The system needs to be actively unresponsive to self antigens (own tissue), innocuous microbial, food and environmental antigens. An over-loaded system is more likely to lose tolerance and become dysregulated.  Anything that is a potential threat to the organism can increase this total stress load on the system.

Healthy immunity is ultimately about balance and can be significantly influenced by environmental / lifestyle factors including diet/nutrients, sleep, exercise, stress resilience and social connection.  We have much more influence on modulating our immune system than we think.

Finally, the science of psychoneuroimmunology has been elucidating the powerful connection between our psychological mind states, neurologic function and our immune system.  So, perhaps, how we “see” the world and how we interpret/perceive the signals we receive (threat vs non-threat) determines how we respond to the world and in turn influences how our immune system responds.

Resilience – Why we need to pay attention to the nature of mind more than ever…

 

Any crisis presents a perfect opportunity to examine the nature of our mind.  Where is our attention going?  Are we ruminating on the latest news of COVID 19, not in any productive way but just becoming worried and anxious.  Are we being present and aware of  what is actually happening right now? The quality of our consciousness from one moment to the next is really what determines the quality of our experience.

I am sharing this from my perspective as a front-line ER doctor who is preparing for a potential tsunami of sick COVID patients here in Vancouver, Canada. In the past few weeks, I have found myself having trouble balancing the need to stay informed on all things related to the outbreak both from a professional and personal standpoint and being in the present moment.  This really hit me the other day as I was intensely reviewing case reports of severe cases in Italy and becoming more and more anxious but drawn to look outside the window by the sound of birdsong.  When I looked outside, the sun was shining, the sky was blue and birds were signing carefree just as any other amazing day.  The juxtaposition of the impending doom of what I was reading (experience in my head/thoughts) versus what was true in this present moment (warm sun shining through the window etc.) was remarkable.  Fortunately, I  was able to shift my attention and re-direct my experience.  I have been reflecting on the idea that we do always have the choice on how we direct our attention as long as we are reasonably aware of the tendencies of our own minds.  It is no doubt much more challenging when we are facing an unknown challenge, drowning in reports and sensationalized news bites that are delivered with ever increasing velocity to our devices non-stop.  This is why, during these times, it is even more important to be deliberate in developing tools and practices to focus our attention, regulate our nervous system and be empowered to determine the quality of our moment to moment experience.

Self-isolation, closure of all our usual entertainment options (restaurants, bars, gyms etc) is a real challenge for all of us who are so used to being productive, active, “busy”, occupied and distracted.  I am beginning to see how this is a gift in many ways beyond the benefits of “flattening the curve” of the pandemic.  What do we do with ourselves when our usual distractions and activities are removed?  Are we bored, miserable, irritable with our partners and family whom we have been forced to spend all day with now?  Are we afraid of our own thoughts?  Fortunately, the internet is still working and we still have endless options of distractions available to us at a single click.  The question is, can we take this opportunity to slow down, to be more mindful, to be more present?  I recall the stories from New York city when they had a prolonged power outage, when many New Yorkers recall this period  as a special time when they could  spend hours just talking with friends by candlelight or looking at the stars.  In a world of so many distractions, noise; retreat – either self-imposed or forced (like now) can be an invitation to being more present, embodied and having a deeper experience of who we are.

This is where meditation is one of the best tools for becoming more aware of the quality of our thoughts and regulating our nervous system.  It is pretty clear that our mind states have profound implications on all of our body system functions including our immune system.  A chronic stress response increases the chances that our immune system can become dysregulated (either under active – increasing susceptibility to infections or over-active – increasing risk of autoimmunity, allergy etc.).  This is why regulating our nervous system is so very important in the face maintaining a good defence system against infectious threats.

Social connection is also vitally important.  Although we are in the need to be physically self-isolating right now, we should do everything we can to connect with our family, friends, our community through technology.  We can still be outside connecting with nature while maintaining physical social distance.  I say physical social distance because in these times, we have the opportunity and need to be actually becoming closer together.

There are lots of amazing meditation apps (Waking Up, Headspace, 10% Happier), online videos, books etc. that can help us get started.  I try to find 20 minutes in the morning to “set-up” where my attention/consciousness lies as well as anchor the baseline of my nervous system before things get busy.  Ideally, I do the same thing before bed.

I will be going into the ER tomorrow for a shift.  I won’t lie, I have some anxieties about whether I will see a sick COVID19 patient who is crashing and who needs intubation.  Will I be able to save this person’s life, will I remember all the complicated steps of doning an doffing personal protective equipment, will be at risk of bringing something home to my family?  How do I deal with this uncertainty and risk which seems ever more present now?

The best thing I can do for myself and for patients apart from being prepared from a technical medical standpoint is to ground myself, be present, regulate my nervous system so that I am prepared to deal with what ever it is that I need to deal with tomorrow. At some point, we can only prepare as much as we can and just do the best we can.   Right now – the sun is shining and the birds are singing.

In health

Lawrence Cheng

Healthspan is more important than Lifespan

 

Longevity is the big buzzword these days.  There is no end to humanity’s search for the magic elixir of prolonged life or even immortality.  With the continuing discoveries and exponential growth of life science technologies and fuelled by increasing computing power, we are hurtling headlong into the unknown of cracking the code of aging and death.  This is certainly not a bad thing but we do need to take pause and to ask the question of what is the point of life extension if  we are not living well, at our highest level of vitality!

What is health span?  Its difficult to define as everyone’s definition of health is not necessarily the same.  We can safely say that it is the period of one’s life that is free from any serious disease or debilitating illness that impacts our daily living. Its important to note that although we have made significant gains in life expectancy over the past century, we have not been that successful in delaying the onset of most of the common diseases of aging.  This means that although we are living longer, we living longer with disease.  In order for us to be truly compressing morbidity or increasing our relative amount of health span we are going to have to “delay” the physiologic aspects of aging.  This is going to require both major scientific breakthroughs but more importantly, implementing what we already know is true – which is that improving lifestyles, behaviours, communities and socioeconomic determinants of health can significantly increase both lifespan and healthspan.  Its easy to lose sight of the fundamentals in favour of new technology which we hope will save us.  This is shortsighted.  People are not living to their highest health or life potential not because they are lacking a pharmaceutical wonder drug (or natural  supplement for that matter) that slows down or turns off the aging process but because we haven’t optimized environmental conditions (internal and external) which allows optimal health to be the emergent property.

There are many determinants for what one would call health span.  In order to live well at our highest vitality, free of disease ideally, we need a body, a mind,  that has the functional capacity to do what we want it do – free of pain, but also a good level of stress resilience (to deal with what life has in store for us), sense of purpose and meaning, love and connection.  It is very difficult to live with a good quality of life without optimizing all those factors. This is the foundation.

To increase our health span relative to our lifespan we then need to delay the onset of the diseases of aging.  We are understanding much more about the molecular basis of lifespan and there is growing evidence that dietary nutrients (kind, quality and amount), caloric restriction/intermittent fasting, exercise and pharmacologic interventions  (metformin, rapamycin)  seem to be able to modulate key pathways involved in nutrient sensing (AMPK, mTOR), autophagy (cellular renewal), inflammation and senescence (cell death). Much of this science is very promising but still very new. Only time will tell.

I would say ultimately though, it is not about a longer lifespan or even health span that really matter but about living well in full vitality with a sense of purpose, love and connection.  This is what we call Whole human health.  Health ultimately is about wholeness at the deepest level – not just a perfectly functioning body and mind. This wholeness emerges from integration.   We have to integrate all these levels – from cellular biochemistry to the biologic networks of organ systems, to the way we perceive and process information, to the way we respond to our environment (consciously and unconsciously), to our relationship to ourselves, to the connection with others and to nature.  It all starts with awareness.

Join Dr. Christie and myself for a deep dive into these questions of what is true health and wellness as well as reviewing the latest scientific evidence for how we can live optimally well during our upcoming retreat Whole Human Health at the Hollyhock Retreat Centre on Cortes Island this September.

 

https://hollyhock.ca/p/919/whole-human-health-functional-medicine-2-0/

 

Whole Human Health

Ultimately, what is health?

The WHO (World Health Organization) defines it as the following:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

Health is not merely the absence of disease.  It is a positive asset that enables us to fulfill our human potential.  Without health – it is hard for us to reach the higher levels of Maslow’s hierarchy of needs.  It is the foundation of the pyramid upon which everything is built upon.

Health is wholeness – integrated at every level – from a cellular to whole being.  What constitutes cellular “well-being one might ask?  The cell is our basic unit of function.  It is actually like a computer that is constantly waiting for inputs/information.  Based on the information it receives, it responds by translating the DNA, making proteins, enzymes and other molecules to maintain homeostasis (balance).  The cell is constantly sensing and responding to the environment.  What happens at the cellular level happens at every level of the organism from a tissue, organ, organ system and finally whole person level.

So health is the ability to appropriately sense changes in the environment and make adaptive changes.  The ability for an organism to self-regulate is essential not only to survive but to thrive!  Sensing on every level is dependent on being able to have sufficient balanced sensitivity and being able to interpret/discern the message/information.  Too little sensitivity means that we will fail to pick up signals that might be important and too much sensitivity can result in over stimulation and usually increasing resistance.  This happens at the receptors within the cell, on the cell surface membrane, organ system sensing systems (for carbon dioxide, blood oxygen levels, blood glucose etc.) to nervous system (our senses), our immune system and how we process information from a psychological level as well.  What information, what messages are we inputting into our cellular computer, nervous system, whole person?  Are we conscious about the quality of this information that we expose ourselves to and the resultant downstream effects?

How do we balance our sensitivity set point so that we can pick up the signals from the noise but not be overwhelmed by the noise.  This is where the practices of mindfulness, meditation, yoga, Tai chi, Qi gong of the Eastern Wisdom traditions have much to teach us.  In this world of too much information,  too much sensory overload, being on-line all the time – our nervous systems are losing the ability to be sensitive and discerning at the same time.  This ‘noise’ is causing illness.  We need to balance this by consciously choosing to create space, to subtract, to distill, to edit what is truly important, to quiet down the mind/body noise to that we can connect to something deeper.

The science of epigenetics tells us that our phenotype (which is the observable composite of physical characteristics) is determined by the interaction between our genes and the environment.  What this tells us is that how we live each and every day – what we eat, how we move, how we sleep, ow we perceive the world affects our biochemistry at a DNA level.  The foundations of health need to address all of these.  Lifestyle medicine should always be the first treatment before any drugs or surgeries unless it is an acute illness that requires prompt intervention.  Precision medicine using “omic” molecular technologies (genomics, proteomics, metabolomics, microbiome) will help us understand our biochemistry and physiology like never before and promises truly personalized medicine. But this will not necessarily give you optimal, vital, radiant, exuberant health which is what we all want!

Health is much more than an optimal physiologic state.  Beyond the bottom part of the pyramid, we need safety, social connection, confidence, achievement and self-actualization.  Fundamental to this development is deep sense of knowing oneself and a radical self -acceptance of who we really are and the ability to compassionately observe our patterns of behavior, self-delusion and escape.  A recognition that we are already whole.  We are not broken.  Discomfort, illness, pain are pathways to lead us to observe and learn and ultimately to become more integrated selves.

Whole Human Health is firstly about recognizing our own innate radiant essence and our own innate body intelligence/wisdom.  These core beliefs than translate and manifest as our behaviors.  We cannot sustainably change behaviours without transforming the underlying core beliefs. The journey to health is all of this…

Health is about being in touch with this essence of being a human being.

Please join Dr. Christie and myself on an experiential journey of whole person health at Hollyhock in September 2019.

For more details: https://hollyhock.ca/programinfo/cheng-christie/

 

Precision Medicine – The Molecular You

There is a revolution that is underfoot that is going to change how we understand our bodies, approach our health and how medicine will be practiced.

This coming revolution is being powered by a super-convergence of technology and empowered consumers.  Advances in biotechnology now allows us to sequence your genome in a few hours, analyze hundreds of proteins and metabolites from a drop of blood.  We can even describe the ecology of your of poop!  Coupling this with the exponential increases in computing power, data storage and wearable devices which can now measure real time physiologic variables and you have a convergence of technologies which are going to change medicine.

Precision Medicine is “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person” (https://ghr.nlm.nih.gov/primer/precisionmedicine/definition).  This is in contrast with the current  paradigm of “one-size-fits-all approach”.  We know now that every one is biochemically unique.  We need to move from medicine of the average to medicine for the individual.  Within each individual there are thousands of genetic and metabolic variations.  We are all mutants, outliers in some aspect.  This is actually good for the most part because because many of these mutations may confer some of biologic survival advantage.

 

“Medicine is for real people.  Statistical humans are of little interest” – Dr. Roger Williams.

The molecular you is the sum total of all the molecules in your body and how they interact with each other.  As we begin to map these out, we are essentially writing an operator’s manual for our body which as it turns out we never got.

The omic technologies of genomics, proteonomics, metabolomics and microbiomics are the foundations of understanding the molecular you.  Genomics is the study of our DNA – our blueprint you might say.  Proteonomics is the study of proteins that have been made from the translation of DNA.  We can now measure hundreds of proteins at once using mass spectrometry.  The complete array of proteins at a given point in time is a snapshot of how your DNA is being translated. Metabolomics is the science of the unique chemical fingerprints of cellular processes.  The power is in the combination of this multi-layered data set.  We have decoded the human genome a while ago now and it did not herald a massive transformation in healthcare.  The reason is because the DNA is only the blueprint.  It doesn’t tell us what is actually built or translated.

What is the promise of all of this information? It will tell us what diseases are you more at risk for and what we can do minimize our risk.  It will tell us how to correct imbalances before they manifest into disease.  It will tell us what medicines to take and which ones not to take.  It will tell us what we individually should eat or not eat.  It will tell us if certain lifestyle changes are changing our biochemistry or not.

Most of our current lab testing measures only a few markers that usually can only indicate disease when it is clinically evident (obvious symptoms).  Most chronic diseases which represents the biggest burden of illness certainly in the developed world have a long latency period.  It often takes many years from initiation of a condition before it manifests into obvious symptoms and detectable disease.  For example, atherosclerosis (hardening of the arteries which leads to heart disease and stroke) starts 10 – 20 years before someone has any symptoms.  The promise of molecular testing is that we can begin to detect patterns of system imbalances many years before and this will give us a head start to correct them.  If we are able to correct the imbalances far enough ahead, we may be able to avert getting the disease all together.  This is upstream medicine rather than downstream medicine when we treat disease at its end manifestations.

However, it is early days yet for this technology.  We have much to learn about how significant a particular molecular pattern or signature might be and what specifically we can do to change it.  We will need enough data from enough people to pick up the signals from the molecular noise.  For diagnosis, we will need ensure that the test is sensitive and specific enough to rule in or out disease without having too many false positive or falsely negative tests that will create anxiety and unnecessary testing, interventions and possible harm.

Ultimately, the ability to understand our bodies and mind at a molecular level is going to empower us to make better and better decisions about our health than we ever have been able to until now.  But the totality of a human being is much greater than the sum total of our measured molecules.  So, in order for this technology to truly transform our health, we will need to be able to translate molecular data into real actionable insights and to combine this with conscious awareness and a deep understanding of our inter-connectivity.

For more information about molecular testing:

http://www.molecularyou.com

 

The Future of Medicine – An Integrative Vision

Medicine is undergoing a major paradigm shift from a reactive, organ based diagnosis and disease management system to an engaged, proactive, molecular based systems approach.  This is being called “4P Medicine: Personalized, Predictive Preventive, Preventive and Participatory.
This new medicine is emerging from the rapidly growing new science of systems biology including the study and application of genomics, proteomics, metabolomics and the microbiome.
The super-convergence of  “omics”, new computational tools and an increasingly engaged and knowledgeable population who are using ever more sophisticated biometric tracking devices and learning from each other through social networks is fueling this revolution.

The promise of the new “omic” technology is nothing short of ushering in a whole scale revolution in medicine.  If you really think about it, we don’t really understand the underlying mechanism for many common diseases.  Take hypertension, diabetes, asthma, Alzheimer’s etc., do we really understand the underlying pathophysiologic mechanisms that are in play in a given individual?  Why does one person manifest a disease at a particular point in time and another not?  We are beginning to understand that it is the complex interactions between your genes and the environment that leads to a certain set of biochemistry/physiology which then translates to a given expression of functioning (phenotype).  This phenotype changes with changes in the environment (epigenetic influences).  Dr. Jeffrey Bland writes about this eloquently in his latest book “The Disease Delusion”.

You change your environment (which includes the sum total of what your mind/body/spirit is exposed to) and you change your DNA expression which changes who you are!

Using “omic” technology we are going to be able to better understand this complex gene-environment interaction as never before.  The ability to analyze your DNA for your genetic tendencies plus the resulting protein expression and downstream arrays of hundreds of metabolites, including an understanding how your micro biome (ecology of gut bacteria) might be influencing all this – will begin to give us a picture of what is really going on in a given individual.  This will in turn give us a better chance of correcting these imbalances at a root level to achieve more like what a cure is rather than symptom management.

We tend to have a never-ending fascination with technology (there is nothing wrong with this at all) but we should be wary about continuing down the reductionist rabbit hole and to not forget that the total is much greater than the sum of the different parts.  Even if we think we can measure everything there is to know about a human being, there will be infinitely more that we cannot quantify in terms or numbers, base codes of DNA etc.

What we need is a vision of the Future of Medicine that includes a balanced view of the new technology but calls us to remember that the “molecular/digital you” is not and never will be the same as the “human you”.  An integrative view includes an ecological whole person approach that understands that our health is not separate from anyone or anything else, but is part of an interconnected, interdependent web of relationships between all of us and our biosphere.

 

I will be speaking at next Integrative Health Care Symposium in Toronto on this topic:

http://www.ihsymposium.com/canada/session/the-future-of-medicine-an-integrative-4p-medicine/