Tag Archive for: systems approach

Addressing the Systems of Health and Disease

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A systems approach to dealing with diseases and conditions is not what we currently do: if you have pain, you want to relieve the pain. That approach may fix the symptom, but it also may not fix the failure of a complex system that caused the problem. If you’ve broken a bone or had a torn ligament surgically repaired, that was not a system failure, but the approach to get things back to normal would be the same. Multiple systems would be involved, not just pain control.

To illustrate the point, I’m going to talk about one of the most complicated conditions: carrying too much body fat. It affects 70% of the population of the U.S. and is a growing problem around the world. My advice for dealing with it goes like this: Eat less. Eat better. Move more. Those recommendations really don’t change, but to permanently lose the weight and keep it off, the number of systems involved is staggering.

A Systems Overview of Obesity

Here are some of the questions yet to be answered about organs and systems that are involved in weight reduction:

  • What will happen to fat cells? The fat cells manufacture hormones that can impact appetite and hunger. At this point, there’s no research to suggest they’re ever reabsorbed.
  • The pancreas produces digestive enzymes and insulin. How will less food or different foods along with more exercise impact their involvement in digestion and metabolism?
  • Our taste buds have developed over the years. Will they change to reduce the taste and feel of sugar, fat, salt, and umami we may crave?
  • Can the impact of insulin on the liver change? Your liver develops a process to convert carbohydrate to fat and store it. Will that be reversed?
  • Will the adrenal gland respond to the decrease in fat intake and cholesterol production to reduce the production of cortisol and lower inflammation?
  • What happens to the microbiome in the long term? Does it adapt? Does it stimulate hunger or decrease it?

I could go on and on, but I think you get the point. It’s complicated to deal with complex systems. We don’t have the answers yet because we haven’t been asking the right questions.

The Impact of Aging on Complex Systems

We know as people age, we lose muscle mass, gain body fat, and lose bone density among many other changes. What we don’t know much about is the specific changes in every type of cell, organ, or system. If we don’t have that, we may not be able to address the correct cog in the system. That doesn’t mean we shouldn’t try; we can take what we currently know about how our bodies change over a lifetime and use that as a starting point. The earlier in life the better, but we still have to deal with individuals and the bodies they have right now.

We live a lot longer than we did 100 years ago. It’s time we began making those years better in every way rather than simply managing pain and other infirmities.

The Bottom Line

This challenge lies before us: Find a way to manage complex systems in order to not just survive but thrive throughout our entire lives. That’s where I’m headed in developing Aging with a Vengeance. We have to deal with the changes from aging that contribute to where we are today, regardless of age. Along the way, we’ll find out the optimal age for preventing some of those issues or at least slowing them down. I’m pumped for this journey to be the best version of ourselves, regardless of our current age or physical state. We just have to keep our heads in the game.

What are you prepared to do today?

        Dr. Chet

How Complex Systems Fail

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If we acknowledge that the human body is itself a complex system and is made up of individual complex systems, then we can examine where things may go wrong to cause disease. In order to “fix it,” we have to be able to identify where things can go wrong. For ideas on that, I’m going to use a paper written in 1998 by Dr. Richard Cook titled How Complex Systems Fail. If you get a chance to read it, please do so at the link below. In the paper, he talks about how large organizations such as healthcare systems and other businesses can fail as complex systems. There are 18 points in the article and not all apply directly to the human body; I’m going to use only the first two in this memo.

Complex systems are intrinsically hazardous systems.

Your heart beats between 60 to 80 beats per minute on average. In order for it to do that, it relies on the muscular system of the heart, the nervous system within the heart as well as the autonomic nervous system, hormones, blood vessels, and on and on. In one heartbeat, there are intrinsic hazards in many locations that can impact whether the heart works well or doesn’t.

Complex systems are heavily and successfully defended against failure.

The best example of this is your immune system. Every day, you’re going to have cells that do not reproduce correctly. If not addressed immediately, they could grow into some form of cancer or other type of abnormal cells, but your immune system recognizes that the protein structure is incorrect and eliminates it.

The same holds true for every system in the body. Some of the trillions of cells in the body fail just about every second of the day, but there are safeguards and defense mechanisms that clean up after the problem cells. If these defense mechanisms didn’t work, none of us would be here.

While there are other points that apply to the human body in the document, the first two set the stage for dealing with diseases and conditions once systems fail. I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: How Complex Systems Fail. RI Cook, MD Cognitive Technologies Laboratory. University of Chicago. 1998.

The System Theory of Disease

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I first heard about systems and disease in a TED talk by Dr. David Agus, an oncologist in Southern California. (You can watch that TED talk by clicking the link above or copying the one in the references.) In it, he talks about how cancer is being treated: attack the cancer directly wherever it’s located. Based on a follow-up in the 12 years since his talk, I don’t know that things have changed a great deal.

The problem is that cancer is a complex system once it gets established. That’s why early diagnosis is critical. He goes on to say that cancers can be cured if caught early; if they’re not, the odds that the cancer can be eradicated decrease tremendously. That’s a little disheartening, to say the least, but out of that came a theory: a systems theory of disease that I’ve been thinking about since I heard that first talk.

Diseases Result from System Failure

The basis for my theory of disease as a system is that we have to look at all systems and organs involved in a disease, not just a specific organ. When it comes to something like cancer, it could include the cardiovascular system that sends blood and thereby nutrients to the tumor, no matter where the tumor is located. Restricting the blood flow to the tumor in some way can certainly impact its ability to gain nutrients, get rid of waste products, and inhibit it from defending itself.

In my opinion, we can use this approach for every disease and condition. We think in terms of doing one thing to be able to deal with a disease or condition: attack what we perceive as the cause. What we have to understand is that a condition such as obesity is not just a matter of overeating and under-exercising. Many of you have heard me say that it’s all about the calories—the end. I’m not modifying that because it really is about the calories, but the diet, the exercise, and other factors may be different for different people to achieve a solution to excess body weight based on genetics. For example, if you want to lose weight, maybe you first need to get treatment for your depression or your insomnia.I think the same is true for cardiovascular disease, type 2 diabetes, and on and on.

Systems and Aging

These days, my focus is on the diseases and conditions associated with aging: loss of muscle mass, excess body fat, changes in brain and memory, hypertension, vision, and so on. Each one is associated with complex systems, and thus must be dealt with in a multi-factorial way. That’s the purpose of Aging with a Vengeance: to find those solutions.

But before we get to that, we need to identify why complex systems fail. What goes wrong? How did they go wrong? That’ll be the focus of Tuesday’s memo.

What are you prepared to do today?

        Dr. Chet

Reference: Dr. David Angus TED Talk. https://bit.ly/2ThlJt5

The Systems Theory of Health

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When we consider Aging with a Vengeance, a systems approach to health is critical. We cannot consider one issue such as high blood pressure or arthritis without understanding that it’s not just a single organ or parts of organs that are involved in improving if not completely fixing a health problem. As Aging with a Vengeance progresses, a systems approach will be a critical component of the process.

The concept of a systems approach to biology and subsequently healthcare originated in 1969 with an Austrian biologist, Karl Ludwig von Bertalanffy. He described what has since become known as General Systems Theory. This is the concept that “systems cannot be reduced to a series of parts functioning in isolation, but that in order to understand a system as a whole, one must understand the interrelations between its parts.”

It seems obvious when you read it, but that’s not how we approach health and disease today. Blood pressure involves the heart and blood vessels, but also the renal system and the nervous system, to name just two others. Our health is reliant on multiple organs working as part of a system and interacting with other systems. That also means that disease does as well. More about that on Saturday.

Tomorrow night is the monthly Insider conference call. I’m going to talk about a review study of the metabolism of artificial sweeteners you don’t want to miss. I’ll also answer Insider questions. Isn’t it time you became an Insider?

What are you prepared to do today?

        Dr. Chet

Reference: J Thorac Cardiovasc Surg. 2016 August ; 152(2): 593–594.

Why Nutrition Is a Process

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A celebrity doctor who specializes in cancer treatment said something that caught my attention, and it goes to this question: why are some people cured by specific treatments while others don’t respond at all? In his opinion, it’s because the cancer creates a new system in the body that competes with the other systems.

The new system may be different in each body once the cancer is established, which could mean that everyone really requires an individual approach. A systems approach would be necessary only if the cancer gets too established; early diagnosis can use treatments that work in most people. Late diagnosis means the cancer has established a system with strengths and weaknesses that are unknown. But the systems approach isn’t limited to cancer.

What’s a Systems Approach?

A systems approach is simply this: we attempt to reach a goal by looking at the interactive nature and interdependence of all the factors in an entity.

Here’s an analogy: you flip the switch for the light in your kitchen, but the light doesn’t go on. What could be wrong? The light won’t work if:

  • Your bulb is burned out
  • Your circuit breaker needs to be reset
  • An electrical outlet somewhere has a tripped GFCI
  • Your switch has gone bad
  • A wire is loose in your light fixture
  • The power is out to your whole house

Turning on a light is easy—my grandson Riley is very good at it and he’s not even three. But if it’s not working, you have to look at each element of the system to find the problem and get the kitchen light back on.

How Vitamin D is Part of Your Bone Health System

While osteoporosis or weight gain doesn’t create a new system like cancer does, there are numerous steps in both processes. On top of that, if we’ve been on the path to bone loss or weight gain, there may be changes in normal metabolism that have to be overcome.

Let me explain using vitamin D for bone health. Whether we make vitamin D in our skin, get it from food, or take it in supplement form, it has to be processed by the liver to become the active form to promote bone growth. If there’s a defect in getting the raw vitamin D from food or a supplement into the bloodstream and on to the liver, not enough vitamin D would be made into the active form. Or there may be a defect in the processing of the raw vitamin D once it gets to the liver. Or there may a defect in the receptor for the active vitamin D on the target tissue. I could go on and on about where issues could occur, but I hope you get the point. Right now, we have no idea where the issue might be for the use of vitamin D in an individual just as we don’t know where the weak point of a cancer system might be and thus where we should attack.

Do we quit? No. We simply use a systems approach—we look at every step necessary to reach our goal and what we can do at each step. We begin with taking vitamin D for a specific period of time. We then get re-tested, most likely a bone density scan. If there’s growth, great. If there’s not, then we either add more D or add calcium or switch to a different form of calcium. Then retest. If that doesn’t work we can add vitamin C or glucosamine, both critical to the manufacture of connective tissue. There are other factors such as smoking and exercise that also impact bone growth. We systematically add new variables or add more of some that we’re already doing. Might this take a long time? Yes. Would we have to pay attention? Yes. But is it a natural approach to complicated conditions? Again, yes. No matter what the condition, if you’re going to try to deal with it nutritionally, that’s the approach you’ll have to take. You have to find what works for you.

The Bottom Line on Vitamin D

The systems approach goes a long way to explain why some people benefitted from vitamin D and calcium to prevent fractures and others did not. The only fact the meta-analysis study proves is that vitamin D and calcium supplementation don’t work for everyone. The key is to move on to the next approach; it may be different supplements or it may even be a medication. More options must be tried until a solution is found for each individual.

Over time, I’m going to continue to explore this concept of a systems approach to nutrition. I have no idea where it will lead, but it’s worth spending more time thinking and researching it.

What are you prepared to do today?

Dr. Chet

 

Reference: JAMA. 2017;318(24):2466-2482. doi:10.1001/jama.2017.19344.