Written by
Josh
On
May 10, 2024
Despite advances in modern medicine, rates of chronic disease are skyrocketing. Our medical paradigm has little resolution for the growing mental health crisis, nor for chronic illnesses like Alzheimers and diabetes. Medical science has significantly improved our capacity to treat and respond to acute conditions, and extend lifespan in some others, but has thus far resigned itself to symptom-management for diseases of a chronic nature.
Despite advances in modern medicine, rates of chronic disease are skyrocketing. Our medical paradigm has little resolution for the growing mental health crisis, nor for chronic illnesses like Alzheimers and diabetes. Medical science has significantly improved our capacity to treat and respond to acute conditions, and extend lifespan in some others, but has thus far resigned itself to symptom-management for diseases of a chronic nature.
My previous article on the metacrisis describes how our default ways of looking at complex systems like the human body are incomplete. By perceiving and therefore modelling the body as merely the sum of its parts, the conventional paradigm of medicine focuses on biochemical irregularities, matches them to symptoms, and postulates that said variables are causative of said symptoms. Our paradigm leads to oversimplified conclusions about disease as it frequently fails to account for the adaptation response of the human organism, and complex systems more broadly.
For example, the last decade or so of Alzheimer’s research has primarily concentrated on the hypothesis that the disease is caused by amyloid plaque, a sticky deposit in the brain prevalent in brain scans of Alzheimer’s patients. This theory has led to billions of dollars in research to find ‘cures’ to remove the substance, with no medication yet to bear clinical fruit (the most recent one, lecanemab, had been hailed as a game changer, only for further evidence to come to light that indicates severe risks including brain swelling). Leaving aside for the moment the fact that much of this theory is likely based on falsified data, alternative research suggests that the substance, rather than being destructive, may actually be part of a protective mechanism created by immune cells (microglia) to conserve the brain. In other words, the plaque buildup may be a response, not a cause. This latter theory has been put into practice through the works of doctors like Dale Bredesen, who have found promising clinical results from multimodal interventions that include treatments to remove toxins like mould and heavy metals from the brain.
Take another example - the leading cause of disability in the US, lower back pain. If a patient goes to their clinician and complains of such pain, the standard procedure is to scan the spine and determine if there is any structural damage. Should disc degeneration or bulges/tears be found, spinal surgery is sometimes suggested if the patient does not recover from physiotherapy and/or OTC interventions. However, a large proportion of the population have degenerated discs - with estimates ranging from 37% - 53% in young adults. Why does a degenerated disc cause pain in patient A and not patient B? In other words, what about all the folk who have no back pain yet have the exact same structural abnormality as someone who does? One growing theory is that the spine might not be causing the pain, but rather the brain itself. The field of mind-body medicine is growing rapidly, and Dr Michael Donnino from Harvard Medical School has demonstrated some solid preliminary results with psychophysiologic interventions for back pain - 64% of patients receiving a mind-body intervention were completely pain-free after 26 weeks.
These are just two examples of how our default paradigm of reductively looking at the symptom and extrapolating a cause is incomplete. Note - I’m not saying that reductionism is not at all helpful for diagnosis (it is!), it’s just incomplete. So I believe the reason we aren’t discovering cures for chronic disease isn’t because we haven’t discovered the correct precision drug to down-regulate marker A, or up-regulate gene B, but that we’re looking at diseases through the wrong lens. We’re honing in on correlation, we’re peering into single variables, and we’re misunderstanding that complex systems adapt. We pathologise this adaptation response without realising abnormal markers may be something the body is intelligently doing in response to something further upstream.
Chronic diseases are propagating and putting more and more pressure on healthcare services. The standard political response here is merely to increase funding, but what good is this if we’re funding the wrong paradigm? It’s like giving billions of pounds to witches and herbalists from the 12th century who aren’t demonstrating replicable results or curative solutions, but were insistent that their worldview was the one from which said solutions would ultimately emerge.
The below article is a summary of my latest understanding of why chronic diseases are rising and how our healthcare system might respond in the future.
Normal doctors rarely test patients for toxins. If a patient is known to having been exposed to high amounts of heavy metals such as on building sites, some forward thinking experts will think to test for exposure. Otherwise, it’s just not even on their agenda.
This is problematic because our environment has been so heavily polluted by myriad toxins that are harmful, or potentially harmful, to humans. A global 2020 inventory found there are 350,000 chemicals registered and being actively used in industrial and agricultural production, three times the estimate of previous studies, and only a small number of which have been assessed for safety. Of note, the actual identity of 50,000 of these chemicals remain unknown due to ‘business confidentiality’ while 70,000 of them are ambiguously described.
Of particular concern is that only a fraction of these chemicals have gone through toxicology testing. Even where toxicology reports have been completed, their scope has been narrow, taking into account acute effects and not the potential chronic conditions that may arise from constant exposure over years.
Countries have different regulatory regimes and business interests, and many chemicals are produced only in certain jurisdictions. For example in Taiwan nearly one fifth of its inventoried substances are not registered anywhere else. Yet many chemicals manufactured or used in one country may enter another country through trade and/or by means of environmental transport (e.g. via the atmosphere and oceans).
More than 60,000 chemicals in the US alone were released since 1950 with no safety testing (the Toxic Substances Control Act (TSCA) in 1976 passed by Congress exempted them from testing requirements), with regulators only being able to enforce action posed by substances of ‘unreasonable risk,’ a burden of proof so high that the Environmental Protection agency was once unable to leverage it to ban asbestos.
Moreover, in our attempts to reduce the load of chemicals that were actually agreed upon as toxic to mammalian life (like mercury), scientists innovated on new substances such as pesticides, but in turn created more toxicity for plants, aquatic life and pollinators. Trying to solve for a single variable (i.e. toxicity of X chemical to mammals) created negative downstream effects on other systems (other organisms).
And this problem is not novel. Lead, the type that used to be used for petrol and gas, is now banned after science and regulatory bodies caught up with its toxicity. In the 1920s, scientists discovered that adding lead to gasoline increasing motor vehicle performance and reduced the wear-and-tear of the engine. Known as an ‘antiknock’ agent, its use was considered normal for decades until the health ramifications became clear. Lead is a neurotoxin with no biological need in mammals, and is now considered unsafe for humans in any amount. Lead is neurotoxic, and is able to cross the blood brain barrier when inhaled, degenerating the brain and central nervous system. It’s been shown to affect virtually every organ and system in the human body, with degenerative health outcomes including faster ageing of the brain, anaemia and lung cancer. The half-life of lead varies from about a month in blood, 1-1.5 months in soft tissue, and about 25-30 years in bone. Although its use has been phased out in cars and other automobiles, it is still widely used in the aviation industry.
Although it’s mainly been banned, a 2022 study from Duke University estimated that leaded gas exposure during childhood reduced the IQ of more than 170 millions Americans by a collective 824 million points. The Duke study suggests that the impacts of lead were so significant that they had the ability to shift people with below-average cognitive ability (<85) to being classified as having an intellectual disability (<70).
And that’s just one toxin!
One of the most disturbing trends in toxicity is the use of ‘forever chemicals’ known as PFASs - poly- and perfluoroalkyl substances. These compounds consist of fluoride and carbon bonds that make them extremely chemically stable, meaning they don’t degrade over time and can ride on the back of different elements. PFASs are ubiquitous - they are used in textiles, clothing, food packaging and skin products, to name a few use cases. But they don’t just stick to the surface of the product they are built into, they actually outgas into the atmosphere, and become deposited into the rain, oceans and soil.
Of the 350,000 chemicals that are on the market globally, approximately 4,000 are PFAS. Environmental toxicological research has focused on around 25 of them, the most widely known being perfluorooctanoic acid (PFOA) and perfluorooctane sulphonic acid (PFOS). Having being recognized as detrimental to health, these specific PFASs are currently being phased out…only to be substituted with other PFASs that haven't undergone thorough toxicity investigations, yet known to have similar super-stable chemical properties.
Although the concentration of PFAS in rainwater has remained relatively stable, scientists are discovering the safe level of exposure is significantly lower than previously thought. PFASs have been linked to immune suppression in infants by lowering the formation of significant antibodies, kidney cancer, lung cancer, testicular cancer, reduced sperm counts, liver damage, lipid dysregulation and more.
(Note despite the ‘forever chemical label’, a 2022 study in Australia on firefighters looked at the potential for blood and plasma donation to clear the body of PFASs. It showed that plasma donation had a larger treatment effect than blood donation, but both were significantly more effective than observation in reducing PFAS levels.)
So even if we do end up producing ‘cleaner chemicals,’ the fact remains there are 100s of thousands of substances in the environment for which we have no comprehensive safety data on, and even if they were banned, what happens to those that are already infused in our atmosphere and our bodies?
These are just a couple of examples of toxicity and the human organism. More and more research is pointing to the harmfulness of substances like mycotoxins from mould, exposure to which may be increasing exponentially due to the types of building materials that new developments are constructed from (drywall for example) and more indoor living, and heavy metals. Not to mention substances like glyphosate, a widely-used herbicide than has been proven to have profoundly negative impacts on everything from nervous system development to fertility yet is used liberally as a weed killer and on genetically modified crops in most developed countries. EMF radiation too - scientists have always dismissed the notion of EMFs from sources like WiFi as being detrimental to health as the wavelengths are non-ionising, Traditionally man-made non-ionising EMFs have been presumed to be relatively harmless, except for their ability to generate heat in tissues and potentially cause electrical shocks. However new mechanisms of damage are being postulated, such as quantum biological ones, and more traditional voltage-gated calcium channels, that suggest that non-ionising radiation does have an effect on the organism.
Interestingly, RFK’s Vice-Presidential pick for the US presidency, Nichole Shanahan, said in her introductory speech last week that environmental toxins were one of the causes of the chronic disease epidemic, naming PFASs, pesticides and EMF radiation among them. I’m not saying all of her claims are fully accurate, but the fact is these issues are now at the level of presidential debate in the US. The Overton window is shifting and I believe this will be a major focus of healthcare over the coming decades.
Indoor living and working has disconnected humans from sunlight. The field of circadian science is growing and the emerging literature is showing that light not only effects sleep architecture but also other health factors including but not limited to immunity, blood pressure and mitochondrial function. Meanwhile, through industrial farmings practices we’ve depleted topsoil to such a degree that micronutrient intake has led to an over-fed, under-nourished phenomenon whereby people think they’re eating healthy whilst the nutrient quality of their food sources has declined drastically. This is especially the case for minerals like magnesium and potassium, not to mention vitamins like E and C. Humans require these micronutrients to catalyse a range of enzymatic activities in the body, as well as to ensure processes like detoxification are functioning properly.
LEDs, computers screens and mobile phones are ubiquitous in modern civilisation. What most of these devices have in common is the emission of artificial blue light (wavelengths between 450 and 495 nanometres.)
Humans evolved over hundred of thousands of years outdoors, but with the invention of the lightbulb we began conducting professional and personal activities after dark. This trend took a leap to the upside with the invention of computer screens and mobile phones, which essentially give us access to artificial light 24 hours a day.
Although there are various local mechanisms by which artificial (and isolated) blue light has been shown to directly disrupt human health e.g. photoreceptor damage to the eye, one primary pathway by which it may damage health is through circadian rhythm disruption. Excess artificial (blue) light at night has been shown to disrupt quality and quantity of sleep, and is significantly correlated with various disease states including lung, breast, colorectal, and prostate cancer, and type 2 diabetes. Since the brain is constantly evaluating its environment to signal the processes it should engage in, when the photoreceptor of the eye senses bright light, the brain configures its internal clock and catalyses the necessary biochemical processes given the light environment (e.g. with AM light, the brain down-regulates melatonin and up-regulates cortisol). Artificial light at night essentially tricks the brain into thinking it’s daytime, throwing the circadian rhythm out of balance.
Circadian rhythm disruption is linked with almost every chronic disease, from cancer to heart disease to metabolic syndrome, bipolar disorder to psychosis. Those who work night shifts have an up to 40% increase in cardiovascular disease and up to 50% higher incidence of diabetes, with the World Health Organisation stating that shift work is “probably carcinogenic”. The invention of artificial light devices, and their ubiquitous use at all times of day, has in essence turned the entire population into shift workers.
Given the sun’s connection to premature ageing, DNA damage and skin cancer (melanoma), many are cautious about sun exposure and the general consensus is sun = bad. However this message fails to account for the potential benefits of natural light on human biology, and does not distinguish between strong intermittent exposure, which can lead to sunburn, and regular, non-burning exposure.
Red light and near infrared light from the sun have substantial benefits including oxidative stress and inflammation reduction, ATP and mitochondria health, improve wound healing, better eyesight and much more. Later rays from UVA and UVB, although with risks, also carry the benefits of lowered blood pressure and better circulation (UVA) and higher beta-endorphin production and vitamin D synthesis (UVB). Some data suggest that sun exposure actually leads to a decrease in all-cause mortality and a reduction in certain forms of cancer, such as breast cancer and colorectal cancer. Multiple sclerosis is another good example - its highest rates are in countries at northern latitudes, and lowest in countries closer to the equator.
Intermittent sun exposure (going on holiday 2 weeks a year) and baking in the most powerful UV rays between 10-4 is likely detrimental to most people’s health. Slow and gradual exposure using early morning rays like red and infrared, is not the same animal. Yet the medical establishment conflates the two without realising the benefits of light for a host of biological processes, including sleep.
Avoidance of sunlight may reduce the chance of developing certain types of skin cancer, but may actually increase the chances of dying from other causes of disease. This is still an emerging field, but my prediction is that light will be viewed in equal importance to food over the coming decades. There is significant potential for innovation here by creating technologies that can mimic the benefits of the sun and upgrading building structures with circadian-supporting lighting systems.
To feed the growing population of the world, society developed modern agricultural methods that have drastically increased crop yields, but in doing so has in many cases decreased the quality of food output, and potentially food security. Modern methods rely on fertilisers, herbicides, pesticides, genetic modification and mono-cropping, all of which increase yields yet have second-order effects that can include less nutrients in crops, more toxins in the environment and in humans, and a less resilient food supply for the future. Antioxidant levels like vitamin C in fruit for example have declined substantially, as has magnesium content in food sources like wheat. A number of studies have also shown a marked decline in mineral availability from crops, whilst I touched on the toxic effects of herbicides like glyphosate previously. Further, topsoil depletion from industrial methods has impacted the nutrient density of our food sources, with one meta-analysis suggesting nitrogen stores have on average fallen over 40%, and phosphorus and sulphur close to 30%.
What this means in practice is that people believe they are eating healthy and yet are often deficient in certain vitamins and minerals that are core to their health. In developed countries for example, it’s estimated that 10-30% of the population have a magnesium deficiency, core to >300 enzymatic processes in the body, a nutrient that has significant implications for cardiovascular health amongst many other things. I won’t unpack the various vitamins/minerals here, but this ‘over-fed, under-nourished’ phenomenon is likely ubiquitous, goes well beyond magnesium, and stems directly from how we treat our soil and crops at scale.
There are a variety of micronutrient testing screens available, but these aren’t to be found through mainstream medicine. A future healthcare system would both test for deficiencies in patients and, on an agricultural level, innovate substantially to reduce toxicity of herbicides/pesticides and encourage innovative farming methods/synthetic bio breakthroughs that maintain topsoil and nutrient density without overly compromising crop yields.
Allostatic load theory states that a system can only endure so much of a stress burden until stress turns from eustress (positive stress that creates a beneficial response in the body (i.e. hormesis or adaptation)) into distress (stress that is categorised as bad for the body and does not lead to a positively adaptive response). It refers to the cumulative wear and tear on the body that results from repeated or chronic stress.
The work of Hans Selye in the mid 20th century was the first to point out that living systems respond to stress in a stereotypical way, regardless of whether the cause is physical, chemical, infectious or psychological. Selye rejected the rationale of studying specific signs and symptoms of disease and instead focused on what patient reactions to illness had in common. Selye made the distinction between acute stress and the universal response to chronic stressors, naming the latter ‘general adaptation syndrome’. The syndrome divides the total response from stress into three phases: the alarm reaction, the stage of adaptation and the stage of exhaustion. According to this model, when the body encounters a stressor, it initially goes into an alarm state, activating the fight-or-flight response. If the stressor persists, the body enters the resistance stage, where it tries to adapt and maintain stability. However, if the stressor continues for an extended period, the body eventually enters the exhaustion stage, where it becomes more vulnerable to various health problems.
Stress is a major component of illness in humans. It’s been indicated in everything ranging from cancer to obesity. Meanwhile, the field of psychoneuroimmunology (PNI), which explores the interactions between the mind, the nervous system, and the immune system, is being increasingly used as a frame, and examines how psychological factors, such as stress, emotions, beliefs, and behaviour, influence the functioning of the immune system and, consequently, an individual's health and wellbeing. PNI science is showing there is a bidirectional communication network between the central nervous system and the immune system, meaning that psychological factors can impact immune system activity, and immune system activity can, in turn, affect the brain and mental states.
In the modern world, a lot of what we deem to be normalised parts of civilisation act as stressors on the human organism. But our nervous systems evolved for different environmental pressures.
When times were less complex and less technology-orientated, there were more acute stressors (potential of being killed being one of them) and yet paradoxically less chronic stressors (e.g. 24/7 news cycles, social media alerts, chemical stressors etc). Note when I use the term stressors here, I refer to any substances from toxins, pathogens and viruses, to intangible factors like light and noise, as well as mental and emotional stressors, that the body perceives as threatening. The key point here with allostatic load/stress as a meta-frame is not that any of these stressors are intrinsically catastrophic to humans, but that the aggregation of them puts excess burden on the system, which then has to work harder to cope. And that modern society is making people reach their allostatic limits sooner because the aggregate burden on the system is greater.
Innovations in the field of neurotech, synthetic biology and psychedelics will likely go a long way in supporting the movement towards stress reduction at scale. However, a core part of education curricula should take seriously the work of scientists like Stephen Porges, whose polyvagal theory shows the impact of a sense of safety for nervous system regulation), and incorporate this understanding in education settings whilst nervous systems are still developing and thus at their most vulnerable (note this theory goes a long way in explaining the mechanism by which lock-downs over Covid did harm to young people’s mental health by reducing opportunities for co-regulation, relational attunement and pro-social feelings).
Doctors and health policymakers should be versed in the following:
In other words:
Despite advances in modern medicine, rates of chronic disease are skyrocketing. Our medical paradigm has little resolution for the growing mental health crisis, nor for chronic illnesses like Alzheimers and diabetes. Medical science has significantly improved our capacity to treat and respond to acute conditions, and extend lifespan in some others, but has thus far resigned itself to symptom-management for diseases of a chronic nature.
