Journal of Advancement in Medicine Volume 12, Number 2, Summer 1999

A New Medical Model

Derrick Lonsdale, MD ABSTRACT: The present period of medical advances may be regarded as a paradigm shift in concepts of health and disease. There is inevitably a transition where the "old" paradigm is in conflict with the "new." Each depends upon the disease model that is in vogue at the time that it was conceived. The present model, accepted by the majority of physicians, as well as their patients, depends simply on "killing the enemy," the attacking agent. This arose, as has been endlessly emphasized, from the discovery of microorganisms. It led naturally to the antibiotic era after the discovery of penicillin. The paradigm shift that is taking place is in agreement with the profound words of Pasteur who is said to have indicated that he had come to believe that the host defenses were more important to consider than the attack by microorganisms. Thus, we are entering an arena that has yet to be properly defined. It requires a new model that involves the body/brain relationship. Such a model is offered here. It is based on clinical experience, circumstantial evidence and thoughtful hypothesis. The Model Most physicians and other health-care practitioners have come to accept the brain/body relationship. Many have little or no idea how this works, however. It is, of course, well known that the "mind" can regulate the physical functions of the body, both advantageously and disadvantageously. This represents the basis of faith healing on the one hand and voodoo on the other. Most are aware that negative thinking is a "downer." What follows is a hypothesis of the mechanics. The new model depends upon the concept of two brains that are functionally distinct. There is no attempt to separate them anatomically. The limbic system is the oldest part of the brain and is clearly a computer. The upper brain is the cognitive or conscious member. Its Address correspondence to Derrick Lonsdale, M.D., 24700 Center Ridge Road, Westlake, OH 44145. 143

© 1999 Human Sciences Press, Inc.

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functions of thought and will are poorly understood, but it is also clear that it has an inhibitory effect on the limbic system. Although the two parts of the brain are present in the neonate, it is the computer that is in control. The bladder, for example, is reflexly emptied without the cognitive being involved. As maturation takes place, the afferent impulses from the bladder are passed on to the cognitive and the reflex can be inhibited. It is thought of as toilet training whereas it is merely maturation. The limbic brain, hereafter referred to as the computer, automatically controls the autonomic nervous and endocrine systems on a purely reflex basis. Hormones, released on cue by the computer, are chemical messengers that provide immediate adaptive reactions, whereas the autonomic nervous system maintains fine-tuning through balanced sympathetic/parasympathetic neurotransmission. The biofeedback mechanisms involved are an integral part of hormonal control. The relationships between the pituitary, the pineal, the hypothalamus and its connections are well known and understood. The hypothalamus is partly endocrine and partly central nervous system, thus acting as the connecting link between the two systems. The computer data processes all afferent information and "decides" on both emotional and physical adaptive measures required, the cognitive brain acting as an "advisor." The hypothalamic/endocrine/autonomic axis controls the well-known fight-or-flight reflex and has been well studied as our response to any form of stress (1-3). A verbal insult results in the predictable reaction of anger and might be seen as a "file" built into the "hard drive." An environmental change, such as ambient temperature, produces a physical stress, resulting in the automatic responses of sweating on the one hand and shivering on the other. Such automatic reactions might be seen as the Yin and Yang of all adaptive changes. All these reflexes can be modified by advisory action of the cognitive, perhaps the best example being that of breathing. Centers in the brainstem control automatic breathing and are purely responsible for survival during sleep. When awake, we can override that reflex mechanism. A disease known as Ondine's Curse, or primary hypoventilation syndrome (4) occurs when the reflex centers in brainstem are damaged. The patient has literally to "remember" to breathe or requires a machine ventilator. Genetically determined damage of this nature can occur in Familial Dysautonomia (5,6). The computer might be compared with a conductor of an orchestra in which the body contains the instruments or organs that must be

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organized into a continuous act of adaptation. When the "orchestra" is in tune and playing together, it can be thought of as the "symphony of health." Disease occurs either because there is diminished or excessive activity of the computer, a breakdown of communication with the organs, or a failure of an organ to respond to the message. What is insufficiently taken into consideration is the amount of purely automatic activity that is controlled by the computer, but appears to be willed, or conscious. The "hard drive" contains "files" that make up the "hardware." The "software" is added through experience and learning and can often control actions that are poorly understood by the perpetrator. Thus, child abuse is incorporated as a "file" that can emerge under any form of subsequent stress, triggering an unwarranted or unpredictable emotional response that can surprise the patient or an observer such as a physician. Sleep walking and talking are examples of complicated actions while unconscious. There is no memory of the event in the morning and it is recorded only by the observation of another, usually the parent of a child. Such children are known to suffer often from bruxism and are often seen to be sweating excessively during sleep, both examples of actions brought about by the computer. Even a temper tantrum, expected in a young child, is a complicated action that is controlled by the computer. The cognitive brain is aware of the action and may even be "enjoying" it, but is powerless to stop it. When such a child begins to "grow out" of his temper tantrums, the first sign is that he apologizes to his parent after one of them. This is the first evidence that the dialogue of maturation is beginning to occur between the computer and the cognitive brain. Enuresis is an example of immaturity in the establishment of an appropriate dialogue between the computer and the cognitive. Other Messengers The brain/body dialogue relies on a continuous interchange of messages between the two. There are many molecules produced by cells that are the intracellular messengers. They might be seen as an "alphabet" that makes up the "words" and "phrases" of a chemical language. One of the most important groups of such molecules is that known as the eicosanoids, for several reasons. The first and major reason is that they are derived directly from essential fatty acids that must be obtained from diet. Linoleic acid and alpha linolenic acid,

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respectively, the initial steps in the omega-6 and the omega-3 pathways, are sometimes known as vitamin F. This is because, of all the unsaturated fats that we may or may not ingest in diet, these are the only ones that are essential to life. They must be processed enzymatically to synthesize a whole array of eicosanoids that carry out a complex of intracellular modification. The two fatty acids that make up vitamin F are useless until they are metabolically processed. These metabolites are stored in cell membranes and are released on cue when a message is received by any cell. They are generally thought of as pro-inflammatory and anti-inflammatory, although this is a gross over-simplification of their many actions. They are part of a complex and sophisticated defense system evolved over millions of years. Since inflammation is the reaction that initiates healing, it is the pro-inflammatory eicosanoids that are released. It is suggested that an injury notifies the computer of the trauma and the appropriate eicosanoids are directed to the site. This is also part of the computerized system envisaged in the whole brain/body relationship. A balanced mix of eicosanoids represents another example of Yin and Yang. Health This is perceived as a state where the computer is in a constant dialogue with the cognitive brain and with the body that it controls for adaptive purposes. We are perpetually exposed to the hostile forces of the environment in which we live and this exposure forms the substance of what is referred to here as "Stress." Homeostasis should be replaced by "homeodynamic" in reference to the continuous activity of the computer as it is adjusting us both emotionally and physically. We go out of balance temporarily in order to express the result of an incoming stress factor to which we have to adapt. If the computer is well organized in both a physiologic and biochemical sense, our adaptive responses will be smooth and relatively easy. After the stress has ceased, we should move back into a state of balance, or homeostasis. There are obvious exceptions where the imbalance is prolonged. Grief, for example, is stimulated by wellknown causes. The balance, or homeostasis, may be restored after a period of time. This is characterized by saying that "time is the great healer." The tearing and facial expressions of grief are mediated automatically by the computer that is programmed to react to that particular stimulus.

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This may seem to be superfluous since it is all well known, but seldom do we think about the mechanisms involved. If a person demonstrates a prolonged emotional state, it is regarded as a psychiatric disease. For example, I observed a woman who had been crying almost solidly, day and night, for about 3 weeks. Her family wanted to admit her to a psychiatric hospital. A series of vitamin infusions were administered and her normal personality returned. It can only be explained by assuming that the limbic system had been in an abnormal state of biochemistry that caused her to be emotionally responsive to the slightest stimulus. It was the hypersensitivity that was abnormal but she was perceived as a psychiatric case because of presently accepted teaching. Very few physicians would have seen her as a biochemical problem, much less administer nutrients intravenously. She would have been treated with drugs and counseling. The obvious question is why or how this comes about. The Key Factor

As has been said, this model depends upon a logical dialogue between the cognitive brain, the computer that it should dominate, and the physical body. The key factor is efficient oxidative metabolism. Loss of efficiency in the computer will cause it to become erratic in its data processing capacity. The more primitive and instinctive drives begin to dominate behavior because of lack of the supervisory action of the cognitive. This is the real, underlying cause of what is generally known as psychosomatic illness. It is also responsible for most of what is conceived as purely emotional illness that is so common. By increasing efficiency of oxidative metabolism, through appropriate nutrition, the overproduction of unnecessary adaptive emotional and physical symptoms begin to disappear. It is the widespread abuse of high calorie malnutrition that is responsible largely for the epidemic of incomprehensible behavior in perhaps millions of people. The evidence for this is twofold. It can be used to explain why the newly ascendant public interest in vitamins and minerals is based upon the results that accrue from their largely empirical, "shot-gun" use. The other evidence is drawn from history, using the knowledge of the action of thiamin as an example of dysfunctional energy metabolism in the central nervous system. It is emphasized that thiamin metabolism is used here to illustrate the fact that it is loss of efficiency in redox potential that is the key factor. Thiamin in its role in brain tissue has been well studied.

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Peters (7) showed that oxidation was impaired in brains of thiamin deficient pigeons, particularly in the lower brain, and thiamin deficiency experiments in humans have shown that psychosomatic symptoms appeared early in the experiment (8). Lonsdale and Shamberger (9) reported 20 adolescent patients, with a variety of emotional and psychosomatic problems, who were ingesting the modern "junk" food diet. Abnormalities in erythrocyte transketolase proved that thiamin deficiency was at least part of the malnutrition and abnormal blood levels of vitamin B12 and folate were observed. This suggested that a form of vitamin deficiency, related to an excess of empty calories, was the form of malnutrition responsible, particularly when the symptoms disappeared after initiation of proper nutrition and vitamin supplementation. A child with unusually vicious temper tantrums was reported (10). The tantrums were accompanied by asymmetric dysautonomic symptoms that could be induced by injecting norepinephrine intravenously. This included asymmetry in the pulse pressures measured in the two arms at the same time, and a difference in the ability to produce sweat by iontophoretic stimulation in the two arms respectively. A difference in the concentration of sleep spindles registered in the two halves of the brain by EEG was observed and one pupil dilated during a temper tantrum induced with intravenous norepinephrine, associated with headache. The asymmetry disappeared in testing this child one year later after dietary correction, supplemented with vitamins and minerals. Lonsdale also reported another case of reversible asymmetric dysautonomia (11). Although there is normal asymmetry in the body, it appears to be related to the directive capacity of the computer. The asymmetry can extend to adaptive function and this can become exaggerated when metabolic inefficiency prevails. Beriberi, known to be associated, at least partially, with thiamin deficiency, causes exaggerated activity in autonomic reflexes in the early stages. If the dietary deficiency continues, the autonomic nervous system begins to degenerate (12). It is clear, however, that thiamin deficiency and beriberi are not synonymous terms (13) and it was shown as early as 1882 that beriberi could be prevented in the Japanese navy by modifying the diet of sailors on a long voyage (14). Takaki conceived the idea that the disease was due to an abnormal dietary ratio of carbon to nitrogen. He victualled a ship with foods to correct this ratio by the addition of meat and vegetables for a voyage that lasted 287 days. He found a dramatic drop in the incidence of beriberi in the crew as compared with a similar voyage where the diet had been traditional. Although his hypothesis was incorrect, he cer-

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tainly showed that dietary imbalance was the cause of a disease that had ravaged Japan for centuries. Now that we have a greater understanding of the biochemistry involved, it is clearly an imbalance between the proportion of caloric to non-caloric nutrients that is the underlying cause. We can postulate that beriberi is really a form of high calorie malnutrition where thiamin becomes a vital factor on account of the carbohydrate content of rice-eating cultures. But it is certainly not the only vitamin involved and the high calorie malnutrition of today is really the modern equivalent of beriberi. Because it is marginal malnutrition with which we are dealing, it is never seen in terms of the symptomatology associated with classical nutritional deficiency. We see fragments of the well-known nutritional diseases in a very early form. Not only are we "what we eat" but we "behave according to what we eat." Perhaps even more importantly in today's world, it is often what we drink that has the greatest influence on our behavior. Coffee, sugar, chocolate and particularly soft drinks, together with a vast array of other sweet "junk" represents the use of these "taste sirens" that are addictive in nature. The relationship with nutrition and neurotransmission is now quite an old discovery (15). Disease This model explains some of the puzzling facts that plague modern medicine. It is suggested that all disease begins as a functional response. The symptoms are often ignored or treated symptomatically for years before organic breakdown begins to show up as what we think of as "real disease." Infection The attacking microorganism is a predator that causes defensive reactions mediated by the computer. Since their discovery we have sought almost exclusively to kill the organism without killing the person attacked by it. The early attempts were epitomized by Ehrlich in his attempts to kill the spirochete of syphilis with arsenic. Since the computer organizes the details of response that includes the mobilization of the immune system and fever, we see such responses as automatically indicative of infection without ever contemplating an alternative source of stress. This is so strongly believed at the present time that physicians are prescribing antibiotics almost reflexly. Patients demand them. As Pasteur recognized on his death-bed, the host

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defenses are not sufficiently taken into consideration. Lonsdale published two case reports where the recurrent episodes of febrile lymphadenopathy were prevented by nutritional intervention (16). In both of the children, it appeared to be hypersensitivity of the computerized defenses that was the underlying cause. Defective thiamin metabolism played a large part in this but high serum folate and B12 concentrations in one of the children suggested defective transmethylation, possibly due to inefficient energy metabolism. From a clinical standpoint, the episodes of febrile lymphadenopathy in these children ceased with correction of diet and administration of thiamin. Serum folate and B12 levels, followed consecutively in one of the children, normalized but increased again when thiamin was discontinued. The conclusion that must be drawn from this kind of natural experiment is that a "flu-like" illness, a sore throat, a cough or rhinorrhea, the traditional symptomatology associated with infection, is an observation of the host defenses in operation. If the computer is hypersensitive because of marginal malnutrition, it is possible that infection is either not the underlying trigger factor or that such an infecting organism is activated by the poorly organized defense system. A family with whom I have been involved for many years gave me some insight into this phenomenon. One or other of the 3 children would be brought to the office periodically with a streptococcal sore throat. Since I knew the mother to be well versed in the principles of good nutrition, I found it puzzling. I discovered that the child had been to a birthday party on each occasion that he had succumbed the next day to the infection. To manage such a situation is indeed difficult since birthday parties are an important part of the social life of children. Unfortunately, it is the "junk," traditionally a part of our social gatherings, that is often the unseen and unbelievable cause of the problem. It is automatically assumed that such an infection is merely an accidental exposure and has no bearing at all on the social occasion, much less on the dietary indiscretion associated with it. The credibility gap here is extremely wide and most people scoff at the idea as being preposterous. Could it be that the streptococcus, proved by throat culture, is "waiting in the wings" to be activated by a variable factor that includes the inappropriate nature of food or beverage? Allergy Various forms of illness, coming generally under the heading of allergy, are so common today as to be virtually accepted as a norm by many people. I often find that allergy is never mentioned in a history

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given by a patient. If the patient is asked about it, the response is usually that this has been present for years and is generally accepted as a thing to be simply tolerated. Another frequently underscored situation is referred to as "my sinuses." It is suggested that the basic reason for vasomotor rhinitis, rhinorrhea, reactions to food that are classified as "food allergy" and other such manifestations are due to overactive messenger systems originating usually from the computer. We know that sympathetic activity dilates the bronchial tubes and parasympathetic activity constricts. If the addition of a pro-inflammatory prostanoid is released at the site, asthma is induced as a result of an adaptive signal from the computer. The ensuing reaction is maladaptive. The cause of satiety from food placed in the stomach is because of a series of signals that crescendo from the stomach to the computer. The satiety center in the hypothalamus induces the sensation of "fullness" that cuts off the ingestion of food. If the computer is made to be hyperactive in its response, it can induce an efferent message that gives rise to a maladaptive response. The sensitivity is in the nervous connections, not the tissue that receives the signal. I have seen a young, mentally retarded woman who had no satiety from ingestion of food. She would eat anything and everything put before her without regard to "feeling full." Anorexia is a well known symptom in deficiency of thiamin. These examples represent the Yin and Yang of adaptive responses in regard to the automatic regulation of food intake. Allergens such as dust or horse dander cause massive allergic reactions in some people in whom there may well be a genetic background. A particle of dust, alighting on the nasal mucosa, sends an afferent signal to the computer notifying it of its presence. It has a threshold of reaction and, if this is lowered, it might result in an efferent signal to the mucous membranes of the sinuses and nose. It is essentially a maladaptive signal and, if coupled again with the imbalance in eicosanoid release, can give rise to overwhelming production of mucus that can then become infected. Such a hypothesis goes far to explain why nutritional guidance, coupled with appropriate supplements, is usually instrumental in stopping allergic manifestations of this nature. It also illustrates the confusion that often appears as to whether a given allergy is "psychosomatic" rather than a "genuine condition" that is purely physical. It is well known that a person can sometimes be seen to react to an observed source of an allergen without the slightest possibility of physical contact with it. The conviction of its dangerous action on the

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patient is enough. A woman, known to be allergic to roses, goes into a room where a vase contains artificial roses and succumbs to an attack of asthma. The cognitive brain, under these conditions, becomes the input factor to the computer. A gentleman seen last year came because of his many years of severe asthma. As a "side issue" he stated that he had become so irritable that he was offensive to his employees. He recognized that his emotional overdrive was something that he deplored cognitively, but knew that he was powerless to stop doing it. By rebalancing his limbic system reactions through proper nutrition and supplementing with nutrients that included omega-6 and omega-3 fatty acids, his asthma ceased. Being an intelligent man, he was also surprised to find that his emotional reactions became controllable. He was much easier to live with and became a better boss in his construction company. Another classical example of this is in the epidemic of "ear infections" occurring in children. The neonatal history often begins with "colic," evidence of an irritable brain rather than an irritable bowel. At about 4 months, his irritability and frequently associated fevers are diagnosed as "ear infections" because the tympanic membrane is inflamed. The assumption that this is due to infection automatically results in repeated use of antibiotics, often followed at the age of about 4 years by the insertion of PE tubes. The final intimation of this iatrogenic disaster is that the kindergarten teacher informs the parents that the child cannot be controlled in class. The model described here offers a completely different explanation for the observed facts. Dietary insufficiency of vitamin/mineral components, and especially omega-6 and omega-3 essential fatty acids, causes irritability of the computer. This irritability represents a hyperactive response to environmental stimuli, resulting in the abnormal release of pro-inflammatory eicosanoids in the middle ear and tympanic membrane. Nutritional correction, particularly withdrawal of cow's milk, at this stage will prevent further acute episodes and the secondary infection that often ensues. It is to be emphasized, however, that the initiation of each of these observed phenomena is due to the irritable brain/body communication problem. The eventual appearance of one of the many syndromes associated with school learning and behavior is a natural sequence of events. This demonstrates better than anything else that it is a brain/body dysfunction from the beginning. It is probably true also that it is the administration of unnecessary and increasingly powerful antibiotics

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that makes things worse. It should be noted that the discussion of "ear infections" in children has come under the subtitle of "allergy." It could easily be discussed in either this or the previous section on infections, illustrating the blurring of traditional diagnostic criteria when this model is used. Energy The discussion that centered on thiamin is intended to be used as a template for a discussion of energy in relation to brain function. It is not suggested that thiamin is anything but an important member of the team that enables redox potential to be efficient. In discussing the cause of Sudden Infant Death Syndrome (SIDS), shown to be due to defective brainstem function (17), there is much evidence of hypoxia in the brainstem (18-21). Thiamin deficiency (22,23) magnesium deficiency (24) and antioxidant deficiency (25) have all been proposed, suggesting strongly that it is defective oxidative metabolism that is the culprit. Obviously it is of no value to deliver oxygen to the tissues unless it is used in creating ATP. The metabolic equation is: Fuel + Oxygen + Catalysts = Energy All three components are required in order to balance the equation. Thus, by increasing the macronutrients that have insufficient vitamin/mineral content, considerable oxidative stress is imposed. This might be compared with choking an internal combustion engine, resulting in unburned hydrocarbons in the exhaust gas. This represents severe loss of efficiency in the engine and it is suggested that high caloric malnutrition does the same thing in human tissues, particularly the brain. We have provided evidence that thiamin deficiency makes the limbic system irritable, resulting in excessive emotional reactions and accompanied by autonomic and endocrine dysfunction. The hypothesis resulting from this is that high calorie malnutrition is a National scourge and that it is largely responsible for much of the decay in personal relations. It can be postulated that vandalism and "road rage," both otherwise totally incomprehensible acts of aggression, might be because such individuals are biochemically unstable. The computer, the more primitive brain within each of us, is more in charge than the cognitive.

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Schauss (26), Schoenthaler (27) and Lonsdale (29) have all presented evidence that diet, childhood and adolescent misbehavior are intimately interconnected and it could easily be suggested that recent behavior of the President is potentially connected to his well-known liking for "junk" food. It is the primitive brain that guides our instinctive drives, including hunger, thirst and sexual appetite and it is this part of the brain that is responsible for the fight-or-flight reflex. If inefficient oxidative metabolism, induced by the nature of diet, lowers the threshold of responsiveness to afferent stimuli, this could explain a whole series of conditions that are presently inexplicable. It also illustrates how "stress" is converted into "psychosomatic" disease. This energy consuming and constant reactivity within the computerized system, perhaps leads to organic breakdown and an extension of the disease process. Another important point should not be overlooked. When we extract the active principle from a plant, we automatically create a drug. Digitalis is the best known example. Similarly, extraction of sugar, chocolate and coffee makes them into drugs. A much more acceptable example is the extraction of cocaine and nicotine. Thus, sweet craving is a form of addiction that is due to over-stimulation of the cells in the brain that give rise to the sensations of taste pleasure. We all encounter people who have great difficulty in discontinuing such every-day items as chocolate and coffee. Many of them have a history of alcoholism in themselves or within their family. There is no doubt that the damage is often done between meals and particularly in the evening when television seems to be automatically accompanied by ingestion of "junk" in the shape of cookies, chocolate, ice cream and other sweet items that include many beverages. Soft drinks, particularly those containing caffeine and, even more particularly, aspartame, are a common source of autonomic dysfunction that includes migraine headaches. Conclusion

High calorie "junk" food is proposed as a special form of malnutrition that can be likened to the early stages of the classic disease, beriberi. To suggest that such a disease can even be considered in the modern world automatically stretches the credibility gap. We had considered that the nutritional diseases, whose causes were found in the early part of this century to be deficiency of non-caloric nutrients, were extinct.

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Evidence is presented that this results in loss of efficiency in oxidative metabolism, particularly in the limbic brain, and results in loss of self-control and primitive behavior. It goes far to explain why emotional conditions, usually treated with neurotransmitter stimulants and inhibitors, respond to correction of nutrition and vitamin and mineral supplementation. Since this part of the brain automatically controls the endocrine/ autonomic axis, many of the symptoms experienced by emotionally disturbed people are dysautonomic and reflect endocrine hormone imbalance. Premenstrual syndrome is perhaps the best example of this.

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