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A Letter to New Physicians: Thoughts on Medicine after a Lifetime of Practice

Published on June 19, 2017

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By way of introduction, I was educated at St. Bartholomew’s Medical College in London England and graduated with MB BS from London University. After National Service in the RAF as a medical officer, I entered family doctor practice under the National Health Service. I immigrated to Canada by joining the Royal Canadian Air Force on a short service commission. In 1960, I did pediatric residency at Cleveland Clinic in Cleveland, Ohio and was then invited to join the staff in 1962. My experience during the next 20 years showed me that what has come to be called Integrative, or Alternative Complementary, Medicine was an exciting and fulfilling way of practice. It is about this that I would like to talk to you.

First of all, ask yourself why you became a physician, for which you may have incurred a frightening financial debt. Was it because it provides a good income? Was it because of your fascination with science or was it because of your desire to heal the sick? Give it some thought because it can make a difference to your choice of practice. Let me pass on to you my experience because I enjoyed my entire medical career and did not retire until the age of 88.

Let’s look at the history of medicine as it has developed. During the Middle Ages there was absolutely no model to explain health and disease. You remember that Louis Pasteur and others like him discovered that microorganisms attacked us and killed us. Therefore, the first paradigm in medicine was an attempt to kill the microorganism without killing the patient. For many years this was extremely frustrating and many unfortunate patients did not survive the “cure”. Then came the exciting discovery of penicillin and the antibiotic era was born. Microorganisms became “the enemy” and the idea spread to killing the cancer cell, or indeed anything that appeared to attack our health. You know of course that we are coming up against some severe problems with reference to the antibiotics. Apart from bacterial resistance, their toxicity was found to be so great that some were diverted to the treatment of cancer cells.

During my tenure at Cleveland Clinic I was a pediatric oncologist for six years. The children with cancer all died and when I had the opportunity I diverted my interest to the study of inborn errors of metabolism and handed the oncology to a colleague. What was so interesting to me was that the nature of the biochemical lesion for inborn errors had to be discovered at birth, giving rise to the state screening laboratory. If not discovered at birth, nearly all of them would become mentally retarded. In many cases, an appropriate diet could be formulated by the discovery of the biochemical lesion. The damaging effects could be prevented. This is preventive medicine at its best.

One day, I was confronted with a six-year-old boy who had intermittent episodes of self-limited cerebellar ataxia. Each episode had left his mental functions a little bit worse and he had the earliest signs of optic atrophy. He had been tested by every conceivable neurological and neurosurgical method, all of which had been normal. By studying his biochemistry it became apparent that he had intermittent beriberi. His inborn error was due to a defect in the ability of thiamine to bind to pyruvic dehydrogenase as its cofactor. Each episode of cerebellar ataxia was initiated by some form of stress such as a cold, a mild head injury, and on one occasion, an inoculation. The biochemistry was apparently good enough to produce cellular energy, unless some form of physical stress was imposed on him. By giving him large doses of vitamin B1 his episodes of ataxia could be prevented.

To me this was a dramatic experience that completely changed my perspective of medical responsibility. I found by simple trial and error that many of the pediatric problems facing me responded to large increments of a completely non-toxic vitamin ( thiamine) used as a therapeutic agent. I began to be aware that Hans Selye was absolutely correct when he formulated the General Adaptation Syndrome. He recognized that an animal’s ability to meet stress demanded cellular energy to adapt. This was intuitive, because knowledge of energy metabolism in Selye’s day was limited. The collapse of a stressed animal was due to cellular energy deficit and he stated that humans were suffering from “diseases of adaptation” because of their cellular energy deficiency. Skelton, one of his students, had been able to initiate the General Adaptation Syndrome in animals by inducing thiamine deficiency.

I started thinking about our medical approach. Since healing is a natural process within the body itself, shouldn’t we be assisting that in addition to attempts to kill the enemy safely? I came to realize that the use of nutritional elements represented the fuel that our cells use to produce energy. Provided that the DNA blueprint is either perfect or that its imperfections can be improved by epigenetic use of nutrients, the blueprint can be manipulated by understanding the nutrient implications. A study of ideal human nutrition in the process of energy synthesis is absolutely essential to our ability to retain complete health in a hostile environment to which we have to adapt continuously.

I left the Cleveland Clinic and joined with a physician who had opened a practice specializing in the therapeutic use of nutrients. The effects on my patients were dramatic and I can only say that this is the formula that was given to us by Hippocrates who said “let medicine be your food and let food be your medicine”. Now we know a great deal about the essential elements that make up human nutrition. It is as though medicine could be represented as a journey on a rough road. It came to a fork in the road and a signpost pointing one way stated “kill the enemy”. The other signpost was perhaps blank and can now be said to state “assist the defense”. Could it be that it is a new paradigm? It is interesting that Louis Pasteur was said to have stated on his deathbed “I was wrong. It is the body defenses that count”.

Perhaps you, reading this, might think about the truth existing behind these words. Would you be interested in doing your own library research to find out what has been written concerning the art and science behind the much maligned “Alternative Complementary Medicine”? After a lifetime of practicing medicine focused on supporting host defenses with nutrients, I am convinced this is the direction medicine should be taking.

As a new physician, you have yet to experience the frailty of the current medical model. You will; and as you do, consider whether simply ‘killing the enemy’ with antibiotics, tamping down the inflammatory reactions, or overriding any of the body’s many innate mechanisms to deal with illness, is working in your patients. If you come to the conclusion, as I did, that these methods simply do not work for many patients, consider the proposition that we must support host defenses in order to let the body heal.

Yours sincerely,

Derrick Lonsdale, M.D.

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The Three Circles of Health

by Derrick Lonsdale MD, FACN, CNS

Published on July 8, 2015

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Physicians who practice Complementary Alternative Medicine talk of and write endlessly about oxidative metabolism. Our present approach is, however, largely shot-gun in character. That is a reflection of our collective ignorance, but the question arises as to whether the application of non-caloric nutrients (vitamins and minerals) is an appropriate methodology in the treatment of virtually any disease, the model on which a great part of Complementary Alternative Medicine (CAM) is founded. Is it truly a paradigm shift in overall concept? We certainly know that it usually, if not always, works. We have a huge amount of information about vitamins and minerals, but still do not know how to balance them. In spite of the general impression that modern medicine is a scientific bonanza I see myself standing on the “beach of knowledge, looking at the ocean of ignorance”

Over the years I have provided my patients with a model that introduces them to the concept of oxidative metabolism in a very simple way and this essay is to describe it. It also provides an intuitive concept of how stress is converted into disease.

The Three Circles of Health: Genetics, Stress and Fuel

The three circles of health presented below are derived from Boolean algebra that seeks to describe the influence of variables by the degree of overlap between them. Genetics, for most of us an unknown factor, always enters the equation, since we are born of parents. With a strong Mendelian defect it may be the unavoidable factor, but the discovery of epigenetics tells us that even this can be modified for benefit since it is the study of how nutrients and lifestyle influence our genes. Cystic fibrosis, an example of a genetically determined disease, can be helped by nutritional implementation. That represents the overlap between the genetics and fuel circles.

Figure 1. The Three Circles of Health

Stress, poorly defined for medical purposes, is defined here as a “mental” or “physical” force imposed by living in an essentially hostile environment. It includes all the variables of mental and physical forces to which we have to adapt as we encounter them daily throughout life. Unless the force, whatever that may be, is overwhelming as in any lethal mechanism imposed, it is not the stress that is the problem. It is how we adapt or maladapt to it that is the problem. The fuel circle is our nutrition.

Let us take a simple analogy. Imagine that you have bought a car. You do not know it, but somewhere in the structure of that car there is a weakness, perhaps a flaw in the engine. As it ages it is being “stressed”, particularly by the hills that it has to climb. One day it breaks down on a hill and when you receive the bill for repairs you are told that the breakdown occurred at the site of the structural weakness. Do you blame the hill or the structural defect, about which you were ignorant? Obviously you can blame neither. The hill was a part of the journey undertaken. But suppose that you never bothered to read the owner’s manual and you have been putting in a fuel that is not consistent with the engine design. If and when the breakdown occurs, it is only the fuel that can be blamed since it created less efficiency in the function of the engine, imposing a greater liability for breakdown. The body has exactly the same problems in principle. This becomes an easily understood concept of how stress is converted into disease, the equivalent of breakdown.

Oxidative Metabolism: Understanding the Fuel

The next part of the model depends on understanding that efficiency in a fuel-burning machine, including the 70 to 100 trillion cells that make up the human body, is defined as the useful work produced by the machine in proportion to its fuel consumption. A car is said to be about 35% efficient, meaning that 65% of the energy produced from burning gasoline is wasted in friction and noise. The body is estimated to be 75% efficient, a very different story.

Figure 2. Oxidative Metabolism

Lack of oxygen (anoxia) is lethal as we all know, but it is not usually known by many as being lethal in excess. Every diver knows this. Thus, in this simple figure, efficiency is plotted against the volume of oxygen being consumed. This volume will be less at rest and will increase in proportion to the mental or physical exertions of the individual. On the left side of Figure 2, oxidants are the equivalent of spark plugs in a car. On the right, antioxidants are the equivalent of the cylinders since they represent the “firewall” that enables the energy to be controlled.

Let us turn to another analogy. Imagine that a camper wishes to light a fire in a clearing in the forest. He risks setting the forest on fire so he puts his fire in a fireplace. But as the fire becomes more flagrant it begins to throw off sparks that also endanger the forest. The camper places a wire grill over the fire in order to catch the sparks and thus protect the forest. Now he wants the fire to burn as fast as possible.

The body has the same problems to solve. Every cell has to create its energy by literally burning fuel. This is called oxidation and it is carefully controlled in “fireplaces” in the cell, known as mitochondria. When we are at rest we use less oxygen and when we exercise physically or mentally we use more. As long as we keep it in the bounds that are represented in Figure 2 by the vertical lines, we maintain efficiency. On the left of the Figure we see the oxidants or “spark plugs” and on the right we see the antioxidants, the equivalent of the wire screen in the Figure. It is to be emphasized that the wire screen is an important analogy because it is only effective because of the multiple wires. None of them can catch the sparks on their own.

Mother Nature knew that these “sparks”, known as free oxygen species, would form under any form of stress and took steps to put together a series of chemicals that all work together like the wire screen in the analogy. It is therefore important to understand that antioxidants only work as a team and any one of them alone does not provide metabolic safety. Nor can we ask whether, for example, vitamin C is “good for any particular disease” in the same way that we might ask whether aspirin is good for headaches. The nutrient scenario is completely different from that of the pharmaceutical treatment method.

The Cathedral Roof

We can now imagine that the oxidants form one half of an imaginary roof and the antioxidants the other half. They must balance just like an architect would design a roof. The whole roof or part of it might fall in or the roof could sway one way or the other. Like all analogies, this is an incomplete representation, but it does provide a basis for understanding the problems facing us in what might be called “repairing the roof”.

Brain Body Relationship

Figure 3, shown below, is an obvious oversimplification but introduces the concept that we have two parts to the brain.

Figure 3. The Brain Body Relationships

The “cognitive” part does the thinking whereas the limbic system is clearly a very complex computer that continuously senses the state of our personal environment. It is responsible for all our survival mechanisms that include the fight-or-flight reflex, and vital components of species survival such as appetite, thirst and basic sex drive. I think of the body as like an orchestra where the organs are like banks of instruments and the cells within them are the various instrumentalists. The limbic system is the “conductor”. The conduct of our daily lives depends on the conductor’s ability to play the “symphony of health”. The two parts of the brain “talk” to each other to modify our behavior. The computer “talks” to the various organs in the body through a balanced activity of the sympathetic and parasympathetic branches of the autonomic nervous system. This system is involuntary and is automated by the limbic system. The computer also controls the glands that make up the endocrine system by a closed biofeedback mechanism. Hormones are really messengers of the conductor’s ability to communicate with the organs. The organs even “talk” to each other.

Oxygen, Nutrition and Health

The last part of this model depends on the tissues in the body that are most dependent on oxygen. Brain is well known to be number one in this requirement, particularly the part known as the limbic system and the brainstem, since they function all the time throughout life. The heart also works full time and is perhaps next on the list. It possibly explains why the ancient scourge of beriberi, due mainly to the vital relationship between vitamin B1 deficiency and ingestion of simple carbohydrate is a disease of the heart, brain and nervous system. Beriberi is still seen in the cultures where rice is the staple diet. It was (and still is) caused by the use of white rice that is produced by milling off the grain cusps that contain vitamin B1 and its “spark plug” colleagues. The excess calories cannot be “burned” (oxidized) efficiently. Many of us can remember that we had a mechanism in cars called a choke. If that mechanism stuck after starting the car from cold, the engine would splutter and the car would hesitate. Black smoke from the exhaust represented unburned hydrocarbons. That is what happens to many people in our modern world who insist on the pleasure derived from eating masses of sweets and simple carbohydrates. They are never able to understand that their many symptoms, usually written off by physicians as psychosomatic, are due to their “junk”. Like white rice, “junk” is defined as a substance that we eat that contains no “spark plugs”. This gives rise to the term “empty calories”. Notice that I used the word “substance” rather than “food”.

The extremely common result of all this is a condition that I have called Functional Dysautonomia. Although published in medical journals, it is not a term that you will find in a medical textbook. It is, however, perhaps the commonest condition in Western civilization since the diet of the masses is frequently appalling. I refer to it as High Calorie Malnutrition and the early stages of the decline that results produces symptoms that are usually diagnosed as “psychosomatic”. In a crazy world, two thirds of the human population are dying from the results of increasing starvation, while one third are suffering disease and decay from overeating the wrong foods.

The Three Circles of Health Revisited: Genetics, Fitness and Nutrition

To summarize, there are only three things that you need to remember in maintaining health. The first is that genetics represents a blueprint given to us by our parents. The second is that “stress” is an inevitable result of living in the world. Injury, infection, toxic substances and business decisions all make up forms of physical and mental “stress”. Stress, if not in itself overwhelming, is less important than the way we adapt to it. The third thing and probably the most important is the way we choose our nutrition. Each of the circles represented in Figure 1 above is dependent on the interplay with the other two circles. Each circle may be the dominant cause of an illness but the other two circles come into the equation. The new science of epigenetics has shown us that nutrition and lifestyle have a direct and important effect on our genetic predisposition. The way we adapt to various forms of stress is by physical and mental fitness, maintained by exercise and nutrition, both of which demand self-responsibility.