Foundations of Functional Medicine: Episode 2
In this episode, Dr. Hartman begins to discuss the pillars of functional medicine. These are the foundations upon which everything else is built. The first of these is Diet and Nutrition. You can listen in as he explores these modifiable lifestyle factors and learn more deeply how they affect our health. There are as many different diets as there are people groups on the planet. So the question is this—how can diets in such different people groups, in different climates, and different places in the world have the same relative outcome, longevity and health?
Diet & Nutrition
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Host [00:00:07] Welcome to Foundations of Functional Medicine with Aaron Hartman, M.D. This is a podcast of Richmond Integrative and Functional Medicine. This podcast seeks to motivate individuals to reclaim their health through education, encouragement, and empowerment by reviewing the basic tenets of Functional and Integrative medicine, as well as discussing new advances shaping the future of healthcare in our country. To learn more about us and keep up to date on other important health-related topics, visit us at www.rifm2021.flywheelstaging.com.
Host [00:00:42] The following discussion is for educational purposes only and is not intended to diagnose or treat any disease or disease process. You should always discuss any medical treatments or interventions, as well as changes in your health, with your personal physician.
Dr. Hartman [00:00:58] In our first podcast we discussed what functional medicine is as well as how I got into this field of medicine. Yes, functional medicine is cutting edge. Yes, it quickly incorporates new research findings into clinical practice, sometimes years before the knowledge becomes recommended in clinical practice guidelines. Yes, it's the tip of the spear in new technologies and how they're being implemented into healthcare. It's all these things, but the basics are still the basics. You want to keep the main thing the main thing. What I'd like to do over the next series of podcasts is take a deep dive into the pillars of functional medicine. These are also referred to as lifestyle medicine, but most commonly referred to simply as modifiable lifestyle factors. These are the foundations upon which everything else is built. We want to start here. Let's rediscover their importance. At the same time, let's learn more deeply how they affect our health. The pillars of functional medicine are the following: diet and nutrition, stress, sleep and relaxation, exercise and movement, and relationships. I'd like to start with the most basic and yet the most fundamental of all the modifiable lifestyle factors, diet and nutrition. Hippocrates, who is the father of Western medicine is credited with the saying in about the fourth century B.C., "Let food be thy medicine, and medicine be thy food. It seems like this would be a simple thing to talk about, but there are literally as many different diets as there are people groups on the planet. What people eat in Nicoya, Costa Rica is vastly different than the typical foods in Sardinia, Okinawa or Loma Linda, California. These areas are the major blue zones that have been currently identified in the world. So what are blue zones? Blue zones are areas in the world that have the highest levels of documented individuals living to 100 years of age and, even past. So to meet the criteria of a blue zone, you actually have to find people that say there a hundred years old, find birth records and verify those. So, it's not just seeing old people, it's verifying that they actually are over 100 years of age. There are also other places in the world that have been recognized to have people that are long lived, but these are the areas that they've actually been able to prove that these people are over a hundred years of age. Some other areas where people are known to live long include the Maasai in Kenya, or the Swiss and the Lötschental Valley. What is striking to me about these people groups is their vastly different diets. In Nicoya, the traditional diet's based on corn. Corn is known as a high lectin food associated with lots of mold. Yet, here it's the major player in this blue zone diet. One interesting tidbit of information is that in their food preparation, they grind the corn on limestone, which has been shown to maximize the nutrient extraction from the grains. They also grow corn on iodide-rich soils. While over in the Mediterranean, at the island zone of Sardinia, lentils are a staple. These are another high lectin food associated with inflammation. So here, the Sardinians will soak the lentils for two or three days and then slowly cook it for another two or three days. This slow process not only decreases the lectins in the food... again, think inflammation, but it makes it much easier to digest. The Okinawan diet as a traditional Japanese, Asian-type diet revolving [around] what you can grow in the yard in the back or what can be caught out at the sea. While in Loma Linda, California, there's no emphasis on whole foods but simply eating a plant-based diet. For some, this extends to a vegan type of diet. While the Maasai of Kenya, known for their toughness and physical prowess, focus their diet on food products that can be produced from cows and dairy, to the extent that sometimes they're even known to drink cow blood. This is the farthest thing from a vegetarian/vegan diet. Finally, the Swiss in the Lötschental valley for centuries were famously known to be the people group that supplied the Swiss Guard to the Vatican. Their diet revolved around rye bread grown from rye in the surrounding mountainous area as well as dairy products. So the question is this—how can diets in such different people groups, in different climates, and different places in the world have the same relative outcome, longevity and health?
Dr. Hartman [00:04:50] We will get into this a little bit, but first, a little bit of introduction. Let's discuss some basic food history. In 1996, in the United States, we were in the peak of the human genome craze. I was in medical school at this point in time, and I was being taught the priority of genes and these "known facts" that 80 to 90 percent of diseases were genetic, pure and simple, no questions asked. At this point in time, in my education, we had less than five hours of nutritional training during medical school, and we were actually told in school that diet and nutrition didn't play a role in chronic diseases such as heart disease and cancer. But, oh, what a change we've seen. Now, according to research from the Harvard School of Public Health, 80 percent of heart disease and 70 percent of cancer can be prevented by diet and lifestyle alone. 50 percent of all chronic disease is directly related to eating processed foods. Now we say only 5 to 8 percent of diseases are thought to be primarily genetic in origin. So, what has replaced genetics as the fulcrum on which to leverage our health? It's diet and lifestyle. In order to have some of the basic tools to understand the current and ongoing food fads, we need to understand the historical progression of diet and nutrition in the United States. This will help to interpret new food trends and crazes as they emerge, and you can be guaranteed that whatever the food craze is today, tomorrow it'll be different. And having the right tools to interpret the ever-changing trends is important. It's even more important than knowing every detail of each one of these trends. Historically, prior to the industrial revolution, starvation, nutritional diseases from privation, plagues, famines, wars, natural disasters, poverty in major cities... these were the major causes for death. At this time in America, most individuals weren't huddled in the cities, but were living in surrounding areas in a rural type environment. It takes an area of population density like a city to create an optimal condition to start and spread acute infectious disease outbreaks. This, in combination with malnutrition due to lack of access to food, produced such disease outbreaks. So, during this point time, the biggest issue was lack [of] access of food, [and] nutritional deficiencies. So, when the Industrial Revolution started, it not only resulted in mass production of weapons and later cars, it bled into mass production of food. This first phase of food modification was simply an increase in production combined with the separation of food into its separate parts for the purpose of improving food availability, bottom line. The most important thing was access to food, pure and simple. The main thing happening in the food industry during this time was improving farming techniques and then processing the food into its separable parts. Your wheat was turned into wheat germ, flour, the husk. Milk was skimmed, turned to cream and whey, cottage cheese, or other milk type products. The nutritional results of this, however, were nutritional deficiencies because of the processes that were going on in this food processing production. So, for example, by 1940, the U.S. Government mandated the fortification of bread with thiamine, niacin, iron, and riboflavin. The reason they did this was nerve damage that was resulting from these deficiencies. So, it had gotten so bad, by 1940 the government had to mandate supplementation or "fortification" to prevent diseases caused by the deficiencies. Corn was also being produced en masse, separated from its traditional food preparation techniques and grown in iodide deficient soils. One result of this was, in 1900, corn was banned from France temporarily due to this thing called congenital cretinism. What this is, is a major birth defect resulting from iodide deficiency in the child at birth from eating iodide deficient foods mainly, in this case, corn. So the question is, how did the Aztecs and Mayan cultures use this as a major food source for almost a millennia and yet not have these kind of health issues? Well, it relates to how corn was being processed. And the unfortunate reality is the way these foods are processed affects our health in powerful ways, mainly due to how pervasive it is in our system.
Dr. Hartman [00:08:44] Corn is a great example of this pervasiveness. Corn is stuck into everything. Corn solids, corn sugars, high fructose corn syrup, citric acid, vitamin C. The unfortunate reality is the way corn is processed affects our health and powerful ways, mainly due to how pervasive corn is in the American food system. Corn and its products are put into corn solids, corn syrups, corn fed to animals, it's fed to cows, chickens, they even [use] citric acid for vitamin C or other magnesium type supplements, the citrate actually is a corn product. One interesting fact is that 69 percent of the carbon in the hair of Americans comes from corn as compared to only 5 percent of the hair in Italians. So just think about that for a second, 69 percent of all the carbon your hair is from corn compared to 5 percent of an Italian. That's a lot of corn. And it's mainly because corn infiltrates almost every aspect of our food system. Soy has a very similar story and combine this with the fact that even if you don't eat these grains, the chickens, the cows, pigs or other commercial livestock are fed diets, mostly consisting of these nutrient deficient staples. So, it becomes this ever-progressive cycle that penetrates almost every aspect of our food system. Some of you may be familiar with Upton Sinclair's, "The Jungle". This book, written in 1906, depicted the privation associated with the then current milk production practices, and its publication resulted in the Clean Food and Drug Act, which later resulted in the formation of the Food and Drug Administration in 1930. At this point time, milk was mandated to be fortified to prevent nutritional deficiencies and the diseases related to milk's processing and the deficiencies and the problems related to this processing. Even though in the past, diseases caused by nutritional deficiencies were commonplace, the link to mass manufacturing wasn't clearly seen. Our country was still in a phase of addressing hunger, starvation, and lack of food access. We were soon to enter the Great Depression and have the time of the Dust Bowl, so simply getting food on the plate was a primary focus. How that happened was a totally secondary issue. In the 1940s, one of the first pioneers in chronic diseases, and how they related to nutritional deficiencies was a Cleveland dentist named Weston A. Price. He later used his research to write his book, "Nutrition and Physical Degeneration". And I'd like to briefly summarize his story a little bit here. The way Weston A. Price got into this whole idea of nutrition and physical degeneration and diseases was that his own son got a dental abscess and died from it. Now in Cleveland, Price thought, "This is impossible. We're in the West. This is a modern world. My son got a dental abscess and died?", and so [he] and his wife decided to go to places where people had health and longevity and just research the foods they ate, how they lived, and somehow glean some information that he could then bring back here to the United States. He traveled around the world to multiple different areas, sampled the food, sampled the water, looked at peoples' hair, took samples of that, sampled their diets, and just took a compilation of all this data, and then processed it and wrote his book. His findings were quite interesting. He noted rate of cavities and tuberculosis, craniofacial malformations. All these were related to exposure to Western type foods. This was his term he used for processed food unavailable to these "less developed" cultures around the world. One of the key findings he discovered was that traditional foods eaten in traditional ways, maximize traditional peoples' health. One example of the many that he discovered through his travels, were the people living in the Löschental Valley in Switzerland. Now, many might not think about this being a primitive area, but this area was not accessible by roads. You had to literally walk for almost a day to get there, so it was not penetrated by road, phones, electricity, and Western foods. And that was the main thing Weston A. Price looked for, "Are western foods or processed foods penetrating these people groups?" And in this people group in Switzerland, he only saw one cavity in every 10,000 teeth. He saw very little dental crowding and normal development of the wisdom teeth. That means they did not have to have the wisdom teeth pulled. Another thing he noted as he went throughout Switzerland, was that there were sanitariums that had lots of people being treated for tuberculosis. So, he started to question, are there any people here from this area, from this Löschental valley? And one of these sanitariums was the closest one to this valley area. It was kind of interesting that in over the 2000 people that had been to that sanitarium, not a single one had come from that area. And this story can be repeated, whether it's the Maori in New Zealand or the Maasai in Africa or the Scottish people on the Outer Hebrides. He noticed over and over again great teeth, no crowding, robust health, no cavities, no tuberculosis. He also noted a change in height. That was one of the things he noticed more an Asian and Indian cultures was that, as people were exposed to more Western foods, their height actually diminished over time. This is something historians have actually known for ages, and the Egyptian peoples as they developed their agricultural system, there's a stark decline in their height as they eat more wheat and grains and became a more 'advanced' culture. We see the same thing in the British Empire from the 16- to 1700's through the 1900's as it became more westernised, which is kind of silly word to say, I guess I should say, as they ate more processed Western-type foods was about a six inch decrement in the height of the average male entering service for the British Empire. So, this concept is not a new one. It's just now we're understanding nutrition is a primary factor in this, not race, nationality, or even time; the epoch in which these people are living.
Dr. Hartman [00:13:57] Around the same time, Sir Albert Howard, who became the author of "Soil and Health", was charged in the British Empire with improving the efficiency of crop production within the British Empire found in the country of India and the far reaches of the British Empire. He studied soil composition, traditional farming habits, production of compost, and the resulting health of plants as well as the livestock that ate them, and ultimately the people who ate both. His main goal was crop production improvement. But what he didn't expect to discover was the association with soil quality on the health of the crops and then how this extended to the local population who ate them. And his findings are quite fascinating. For one thing, he discovered there's a need for many different kinds of bacteria and fungi in the soil to extract out the minerals and then make these liquified or solubilized so that the minerals can be used by the plants that are growing in these soils. This requires lots of organic materials in the form of compost. The second thing you realize [is] that there's a need for oxygen in the soil for this process to happen. In moderate water tables, overwatering, poor irrigation, and poor drainage would all prevent this from happening. Small canals or tracts are formed in the soil from earthworms or left after old plants die and decompose. This also helps to facilitate the drainage, or improve the movement of water, within the soils. Finally, he discovered chemical fertilizers have an immediate effect on boosting farm production, but over time they acidify the soils, and this acidification destroys the living microbes in the soil, thus sterilizing the soil. This greatly impedes the extraction of minerals from the soil, and over the long term it decreases the productivity of soil, and later on the health of the animals that eat the plants grown in the soil. So, what do we learn from these two pioneers? It's this simple concept: that nutrient-dense, traditional foods, grown in living compost-rich soil, are the basis for individuals' health.
Dr. Hartman [00:15:38] One thing I want to emphasize right now to all the listeners, is not to get burdened down with all these facts and then get stressed out about this, but to focus on the reality that the fix is simple. But today we see a vastly different picture than the one our parents and grandparents saw. We are so efficient at food production in our country that the federal government pays large farmers not to till the soil, and we're diverting corn from food production to ethanol production. This only happens when there is an excess of food production. Yet, our poor are overfed and malnourished. The result is that obesity is rampant in inner cities among our poor, and diseases like diabetes and tuberculosis are on the rise. According to USDA collection data, 80 percent of Americans are deficient in magnesium. 38 to 60 percent of Americans are deficient in any one B vitamin and close to 80 percent are deficient in vitamin D. These low-level deficiencies over time can contribute to chronic diseases. For example, magnesium is required for the proper function of insulin on cell receptors. B Vitamins are important for cell signaling and regulating DNA activity through a process called methylation. Vitamin D, which is actually not a vitamin, it's a hormone, has its receptor on every single cell in our body, and it is important for calcium entry into bone (and arteries) as well as immune regulation, preventing viral infections, and cancer cells from growing. Vitamin D's function and levels can be related to outbreaks of influenza, for example, and it [influenza] tends to come to a local community during the lowest levels of vitamin D in that area. Typically, this occurs in the midwinter. There is interesting research showing that high doses of vitamin D given at the beginning of the onset of flu can cut the length of the illness by a little over a day. This is similar to the outcome of a well-known drug used to treat influenza called Tamiflu. Or taking vitamin D daily during the flu season can also help to prevent it. The point being is deficiencies of vitamin D are directly correlated with increased incidence of certain viral infections.
Dr. Hartman [00:17:28] So everything I've discussed so far is based on an understanding of nutrition from a 20th century perspective. What we've learned in the opening decades of the 21st century have further expanded our knowledge of the nuances of food, its nutritional content, and how that affects our health. And this new information is further demonstrating the concept that real food produced in living soils, can have a profound impact on one's health. For starters, we now know about a class of plant nutrients called phytonutrients. These include polyphenols and terpenoids. So, what are these, and what do they do and why should I even care? Well, first, these are chemicals made by plants for protection. Typically, they help make the plant less edible to bugs, birds or insects and are markers for increased plant resilience that are produced when a plant is stressed in nature. Second, in humans, these plant chemicals have many beneficial actions; they can modulate our immune system, activate DNA, help with DNA expression, and they can actually be food for certain kinds of bacteria and stimulate the growth of these healthy bacteria. The reality is, we still don't know all that they do. One example of this are the curcuminoids in turmeric that give it its color and are currently known to modulate about 80 different biochemical processes in the human body. That's how many different processes just one of these plant colors modulates. We have no idea about all the rest. So the reality is that we are just beginning to learn what these plant chemicals even do. And as I mentioned, these polyphenols, or terpenes, are represented in different plants by their different colors. For example, carotenoids are a group of plant chemicals important for visual health. They give carrots and squash their yellow orange color. Curcuminoids create the deep orange color in turmeric, a spice that's now known to be associated with decreased risk in Alzheimer's disease and cancer. High consumers of turmeric have a 400 percent decreased incidence of Alzheimer's dementia. These plant chemicals help set the tone for our immune system. Another one of these, resveratrol, is in grape skins. Proanthocyanins... That's a big word, right? ...are another of these colors. They make the red, blue, purple colors in different fruits and vegetables and berries. This is where the red in apples or the blue in blueberries comes from. The levels of these important plant chemicals are increased in the plants by natural stressors. When the plants are grown in greenhouses with artificial light or herbicides, they make less of these chemicals. Hence, the difference in the flavor and color of a tomato grown in your backyard versus tomatoes shipped across the country to your local grocery store. If you'd like to learn more about this concept, there is information on this topic on our website that you can download under the Phytonutrients spectrum food guide.
Dr. Hartman [00:19:58] The next level of plant nutritional complexity is plant RNA. RNA are messenger molecules that tell the protein producing factories of your cells, called ribosomes, what proteins to make. DNA makes RNA and RNA make proteins. While plants have RNA that, when eaten, can help program your body's DNA to react in certain ways, the food you eat is actually information for your body. That is astounding! And when you eat raw vegetables, they contain more of this kind of information than cooked vegetables. Processed fruits and vegetables have even less of this RNA and in some process canned foods, almost all the RNA is destroyed. I wish I had more to say about this new topic, but its discovery is only two years old and we're just beginning to learn about the concept of food as information. Stay tuned.
[00:20:41] The last level of food complexity I would like to talk about are the soil bacteria and fungi in the soils where the plants are grown. These are the long-forgotten workers that extract minerals out the soil and make it available for plants' roots. Fungi grow in the soil but congregate around plant roots and secrete enzymes and organic acids that then make a thin fluid layer around these roots. This symbiotic connection with the fungi connects the plant roots to the soil, improving nutrient extraction from the soil. In combination with organic materials in the soil and soil bacteria, a rich interconnectivity is produced that creates a microenvironment that improves the plant's health. Did you ever wonder where the cow milk gets its calcium from, or where all the minerals in the cow's bones come from? These are extracted during the digestive process from grass, but this grass first extracted it from the soil, which need the health of the soil bacteria and fungi to extract that from the rocks that were degraded in the soil. What is even more extraordinary is that small amounts of these bacteria are also in the plants that are grown in this healthy soil. This enables us to take a simple head of cabbage, shred it, place it in a salty brine, and in one week it ferments into sauerkraut. Where did the bacteria come from that helped ferment the cabbage and turn it into sauerkraut? They come from the soil that that head of cabbage was grown in. A nursing mother, who also eats these plants grown in the soil, will secrete small amounts of these bacteria into her breast milk, and then feed these to her nursing baby. That is astounding. This also explains how clabbered milk is made. You can take the fresh, unpasteurized milk from a cow, set it out, and over two or three days, it ferments and separates into curds and whey. But all this information also helps us to understand how using acidic fertilizers can affect this fragile ecosystem. The point of this short story on plant health and nutrition is not to overwhelm you with minutia and details on farming and nutrition, but to impress in your mind two simple things. The first is the complexity of real, whole food. The second is the impact that the process of farming and the process of bringing food to your local store has on the nutritional value of the food that you put on your plate, and on the plate of your family. The way in which the soil's tended, the way the crops are planted and maintained, how it's gathered and then shipped to you, all impacts the nutritional value and thus how it affects your health and that of your family. I would definitely encourage anybody listening to this right now to learn more about this topic. There are reading resources available on our website under the reading recommendation. I referenced a few of those while I've been talking today. You can use these as a starting point in your discovery about nutrition, soil, and your personal health. Armed with this information, you will have the ability to critically evaluate new food trends and diet fads and protect yourself from going down the wrong trail with some of these new fads. In the next podcast episode. I'd like to take a brief overview on some of the current food trends or trending fads.
Host [00:23:32] We hope you found today's episode useful and informative. Please see the show notes on our website at www.rifm2021.flywheelstaging.com in addition to many other resources and educational materials, we'd also like to invite you to subscribe to our podcast to keep up to date with new episodes. You can find us on Apple podcasts or wherever you listen to podcasts. Please also consider giving us a five-star rating in review so that others can gain access to this information. You can also find Richmond Integrative and Functional Medicine on Facebook and Instagram.