Thursday, July 7, 2011

The Progression of Disease According To Oriental Medicine: Part 2

In Part 1 of this series, I presented the overview of the progression:

1. Normal discharge and elimination
2. Abnormal discharge and general fatigue
3. Aches and pains signalling sluggish blood circulation
4. Blood quality decline with chronic discharge
5. Accumulation of excess nutrients in circulation
6. Storage of excess nutrients in various compartments
7. Nervous system disorders
8. Delusion

In that post I also presented what happens in stage 1, health, and stage 2, temporary changes in elimination and physical, emotional, and mental activities as the bodymind attempts to metabolize the excess nutrients.  In this part, I will look at stages 3 and 4.

3. Aches and pains signaling sluggish blood circulation

In Chinese medicine, we have a principle:  "If there is pain, there is impaired flow; if there is good flow, there is no pain."  This encapsulates the direct experience that if anything impairs circulation to any part of the body, that part will suffer some type of discomfort.  From this experience, Chinese physicians realized that if any part of the body suffers from some discomfort, this signifies an impairment of circulation of vital blood, nutrients, fluids, and nerve impulses to that part or associated parts.

(By the way, this principle applies equally to social-political and environmental disorders as well.  Social-political disorders arise from poor circulation of resources, allowing some parts of the body politic to suffer deficiencies while others have excesses, creating tension and inflaming passions.  Environmental disorders arise when one organism monopolizes excessive resources while other organisms suffer deficiencies.)

All assimilated nutrients temporarily affect the composition of the blood.   After meals, we see increases of blood fats, sugars, amino acids, vitamins, and minerals.  The body tries to maintain healthy blood levels of water, fats, glucose, cholesterol, minerals, etc. regardless of diet.  If a meal contributes more of any of these factors than the body can readily manage or easily store, it will temporarily affect blood circulation while the body works to remove the incoming nutrients from the blood and store them in appropriate places.  

However, if a person continuously eats three or more meals daily providing excess nutrition, more than the body can use quickly or easily store in an appropriate location in a non-toxic form, this can result in a more or less continuous overabundance of nutrients in the blood, and that can result in a more or less continuous alteration in blood circulation. 

Most people in industrialized nations have had the experience of eating a large holiday meal (feast) and feeling simply overloaded, sluggish, short of breath, and fatigued afterwards.  This provides a direct experience of how excessive nutrition places a burden upon the body, particularly the cardiovascular system, and the effect can last for several hours or more.  If a person feasts 3 times daily, the cardiovascular system will have to deal with excessive nutrition almost continuously through the day. 

High-fat blood sample. Source: Case Reports in Medicine

As I have discussed here, Western research has also shown that rich, i.e. high-fat, meals increase blood coagulation factors. High-fat meals have been shown to increase platelet aggregation, fibrinogen, factor VII, and other hemostatic factors; meals rich in saturated fats (e.g. butter) having the strongest procoagulant effect, followed by meals rich in monounsaturated fats (e.g. olive oil).(1, pdf

Thus it seems that Western research may support the Oriental medicine perspective that an excessive intake of rich foods can produce sluggish blood circulation.  The thick sluggish blood can’t properly nourish, lubricate, or detoxify the tissues, including the heart and brain.  The tissues don't get enough oxygen, and waste products accumulate faster than they are removed.  These internal changes reach our awareness as aches and pains and disturbances of normal function.

In line with this, Kuo et al found that fat ingestion can induce myocardial pain (angina pectoris) in patients with coronary artery disease (2).  Afaq et al found that patients with excess blood cholesterol had reduced oxygen delivery to the calf muscles and consequent shorter time to claudication, which involves pain in the calves along with decreased ability to walk (3).  Mattson et al demonstrated that dietary cholesterol affects serum cholesterol in a dose-response fashion; a cholesterol-free, 40% fat diet produced average serum cholesterol of 164 mg/dl; adding 126 mg cholesterol produced an average serum cholesterol of 174 mg/dl; 212 mg cholesterol daily raised serum cholesterol to an average of 181 mg/dl; and 317 mg cholesterol daily raised the average to 198 mg/dl (4).  Hunter-gatherers, non-human primates, and wild animals have serum cholesterol levels below 150 mg/dl (5, pdf), showing that nature prefers a serum cholesterol below 160 mg/dl.   

Total Cholesterol In H-Gs and Wild Animals.  Source: 5

 Other populations with high immunity to cardiovascular diseases also have average serum cholesterols below 150 mg/dl,
--> including rural Chinese (127 mg/dl, 6), Tarahumaras (125 mg/dl, 7), and Caucasian men eating macrobiotic diets (147 mg/dl, 8).  Based on this data I have revised my views and now consider anything over ~160 mg/dl excess serum cholesterol.

According to Oriental medicine, the following signs and symptoms all reveal developing, diet-induced blood stagnation:

muscle pain and tension
menstrual cramps
moderate aches and pains
intermittent abdominal discomforts
sleep disturbances
breathing problems
heart disturbances
chills and fevers
motion and coordination problems

Due to disturbances of blood circulation to the brain and heart, as this stage develops the individual may also experience more frequent mental and emotional disturbances such as hyperexcitability, worry, insecurity, sadness, depression, frustration, and impatience.

To restore balance at this stage, one must remove the causes, maintain a healthy diet with a negative balance of items taken in excess, take appropriate exercise and rest.

Assuming interruption of this process early in its development, recovery from this stage requires restoring the free flow of blood which will require several days to several weeks of healthy diet and lifestyle.

4. Blood quality decline and chronic discharge

If someone continues to consume an excess of some or all nutrients past stage 3, the blood quality gradually declines because the sluggish circulation slows down removal of wastes from the blood by the liver and kidney. Consequently, the whole bodymind system progresses to chronic illness and development of chronic abnormal discharges.

In general, according to Chinese medicine, chronic blockage of blood circulation generates heat (inflammation) in the blood, which gradually affects the entire body if not corrected.

As excess nutrients in circulation gradually but increasingly impair circulation to the lungs, large intestine, liver, kidneys, and skin vessels and pores, the organs can’t properly detoxify the blood and the blood, in turn, can’t properly nourish, moisten, and detoxify the skin.  

In a healthy condition, the body controls the growth of abnormal cells.  However, when the blood  constantly contains excess nutrients that cells need for growth and replication (amino acids, fatty acids, cholesterol, etc.), and the immune system is impaired by poor circulation and accumulation of toxic wastes, abnormal cellular growth can occur unchecked, producing first benign tissue overgrowths like skin tags, moles, bunions, and so on.  If left unchecked, this process eventually leads to malignant growths.

Thus, skin abnormalities herald this stage of disease. As the skin becomes overburdened with metabolic wastes, skin diseases can develop, often in a step-wise fashion from minor to major.  At first the skin diseases may come and go with more or less inflammation or infection.  If left uncorrected, the underlying systemic imbalance will lead next to more constant and serious disorders, generally in a step-wise fashion:
1. pimples, spots, rashes, moles, warts, bunions, dryness, etc.
2. eczema, psoriasis
3. skin cancer
As the blood quality declines, while also containing surplus nutrients, it gradually becomes a favorable environment for microbial or abnormal cellular growth, producing blood disorders progressing gradually in seriousness:
1. chronic infections
2. blood malignancies

Other signs of this stage include chronic nasal discharge or sinus congestion, irregular bowel movements, abnormal sweating, rapid respiration, frequent urination, bad breath, chronic vaginal discharges, and chronic unpleasant body odor, all produced as the body attempts to use every possible channel of elimination to get rid of the excess stuff in the blood, attempting to prevent accumulation of these wastes in the tissues. 

By careful observation, Chinese physicians discovered that when the body gets too hot and dry, it produces thicker, darker, more odorous secretions, and when it gets too cold or damp, it produces thinner, lighter secretions.  Thus, darker, drier, concentrated, hard to expel, strong smelling, and more concentrated urine, mucus, feces, sweat, and odor all indicate a body afflicted with heat that can arise from chronic excessive intake of heating and drying, or yang (pronounced "yahng") foods (e.g. red meat, spices), and clear, copious, more watery, runny, and less odorous urine, etc. all can indicate a body imbalanced by excessive intake of cooling and moistening, or yin (pronounced "yeen") foods (e.g. fruits, ice cream).  A person who overconsumes both types of foods can have a mix of both types of symptoms and signs.

Since the blood serves as the material foundation of the mind, as the blood becomes continuously and progressively sluggish and toxic, more chronic mental and emotional disorders arise, such as nervousness, oversensitivity, depression, hyperactivity, confusion, and disorientation (loss of purpose), along with an increasing sense of alienation from one’s community.

Chinese medicine categorizes foods according to whether they are relatively more yin—or cooling, moistening, and draining—or relatively more yang—heating, drying, and congesting.   In terms of mental-emotional effects, excess intake of more yin items (e.g. ice cream, sugar, fruits) produces a more withdrawn, passive affect,  and excess of yang items (e.g. red meat, spices, greasy foods) produces a more aggressive affect. 

To restore balance at this stage one must eliminate the excess intake, eat an appropriate diet, take exercise and rest, and employ special medicinal foods, drinks, and compresses. Recovery will take from 10 days (for plasma renewal) to 4 months (for red blood cell renewal).


nothing91 said...

Wow, how did those fat-happy Inuit manage to get such healthy cholesterol levels? Amazing!

Oh well -- outliers don't disprove anything around here.

Their blood must have been thick as mud though, I can tell you that. :-)

Erik said...

Hi Don,

What do you think of the argument that low cholesterol in hunter gatherer populations stems from infections and parasites? The Jaminets from the Perfect Health Diet blog make a very convincing argument that low cholesterol may not be so healthy and that it is likely due to infections. Scientists like Cordain may have misinterpreted past studies if this is the case. Not to mention that the highest mortality rates around the world are from populations with low cholesterol levels.

Shouldn't we be more concerned about oxidized cholesterol than the actual concentration if we are to prevent heart disease and other western diseases?



Bog said...

The good cardiovascular health of inuits is a rather myth.

"The evidence for a low mortality from IHD among the Inuit is fragile and rests on unreliable mortality statistics. Mortality from stroke, however, is higher among the Inuit than among other western populations".

"Low incidence of cardiovascular disease among the Inuit—what is the evidence?"

Moreover, traditional choletrol profile is not perfect indicator of cardivascular disease risk.

“..a recent study by Foo and colleagues shows that HPLC diets may accelerate atherosclerosis through mechanisms that are unrelated to the classic cardiovascular risk factors”.

Clinical Implications of Basic Research. A Look at the Low-Carbohydrate Diet"

nothing91 said...

"Mortality from stroke, however, is higher among the Inuit than among other western populations".

That's also true of the Japanese. Uh oh! :-)

Don said...


Inuit have an unusual diet, extremely high in marine omega-3s, enough to give them a high incidence of bleeding disorders and hemorrhagic stroke. A diet very high in PUFAs increases excretion of cholesterol. Marine oils reduce coagulant activity.

So these outliers prove that if you have a very high intake of PUFAs from marine oils, and live in the Arctic demanding an extraordinary caloric intake, you can eat a high fat diet and have low blood cholesterol. But not avoid strokes or hypertension or severe osteoporosis, all of which occurred in isolated Inuit.

Stroke, 4 times greater among Greenland Inuit than among Caucasians:

Hypertension in isolated Inuit aged 40 y or more:

You can't generalize from outliers to general population because they have unusual environments and diets.

And did you notice, the Inuit have cholesterols of ~140, about 17% higher than the other H-Gs which have levels more like ~120?


Mean total blood cholesterol of healthy human neonates is about 72 mg/dl:

Is this due to infections and parasites?

The Mattson study lowered serum cholesterol by lowering dietary cholesterol, not by giving the people infections and parasites.

Don said...


Yes, it is a myth. As I noted, they have hypertension and stroke.

The mechanisms of atherosclerosis in HPLC diets may include hemostatic factors. Elevated Fibrinogen and blood viscosity increase IHD risk by ~4 times:

I think it possible the chronic vascular ischemia due to chronic hemostasis is one if not the major driver of arterial inflammation leading to atherosclerotic changes.


Stroke incidence in Japan not much different than the U.S.:

"Average annual incidence per 1,000 in resident greater than or equal to 20 years was 2.61 for all strokes (3.42 for males; 1.88 for females), 0.20 for subarachnoid hemorrhage, 0.61 for cerebral hemorrhage, 1.51 for cerebral infarction - rates similar to those reported 10-20 years previously for the United States."

Probably due to too much sodium relative to potassium, and too little magnesium (due largely to eating white rather than brown rice). (I never said typical Japanese diet was ideal, it contains too little fresh produce and too much white rice.) But ischemic heart disease much lower in Japan, so overall CV mortality is lower in Japan.

nothing91 said...


"Stroke, 4 times greater among Greenland Inuit than among Caucasians:"

These were not isolated Inuit. "The study comprises only patients admitted to a Neurosurgical Department." It sure seems likely that western foods had made their way into their diet, so surely we can't assume that this reflects the health of pre-westernized Inuit. (Also, we're talking about incident rates of under 1 per 10,000 here.)

"Hypertension in isolated Inuit aged 40 y or more:"

Yet, per the study, "a low occurrence of ischemic heart disease."

"And did you notice, the Inuit have cholesterols of ~140, about 17% higher than the other H-Gs which have levels more like ~120?"

So what? You said (pretty much) that less than 150 is good. You even included "Caucasian men eating macrobiotic diets" at 147 mg/dl as a part of your argument.

Here's the point. Taking extreme positions such as "low-fat is best" or "high-fat is best" requires cherry-picking the evidence. It requires ignoring some evidence but not other evidence. That's why we can argue all day about H/G's like the Inuit and get nowhere.

No one who is truly unbiased can get sucked into such extremes, because the evidence doesn't support either one.

When it comes to H/G cultures we often see this in the blogosphere with the Kitavans and Inuit. The "high fat is best" folks harp on the Kitavans' shaky CVD markers (while ignoring low CVD incidence) and say things like "Well just because they ate that way doesn't mean it's optimal." The "high carb is best folks" do the exact same thing when discussing the Inuit, while also referencing data regarding Inuit whose diets have been infiltrated by Western foods (as if it somehow applies to the Inuit of old).

Both sides make the exact same cognitive errors. Both sides recognize that the other side makes these errors, but neither is able to see it in themselves.

To someone like me who recognizes this and is capable of not getting sucked into extremes, it can all be very amusing to watch. (Add the extra excitement in this case of someone flipping from one extreme to another while continuing to make the same cognitive errors, and things really get fascinating.)

I really wish we could all just stop it, but there's no indication of that happening.

Jaana said...

Don, your latest posts on TCM have been very interesting. But this seems oversimplified to me. I mean, only excess cases are discussed.

Many people who end up broken after paleo/low-carb often have a deficiency condition. I ended up with a severely deficient yin after ketodieting for 6 years. Most of it was maintenance, so I was not deficient in calories, but the constant stress that it caused depleted the yin (kidneys, heart).

Also most of the diseases of civilization have a component of deficiency, i.e diabetes.

As it is not always easy to differentiate deficiency heat (caused by too little yin) from excess heat (caused by too much yang), I was kind a hoping that would be included in your first articles about TCM.

Maybe in the future?

Sue said...

Re neonates: