“Is Life Worth Living? That All Depends Upon the Liver.”-William James

So I mentioned earlier that the liver is the dutiful clerk of the body, just going about its work, doing hundreds of tasks which nobody else seems to want to know about or understand, not attracting too much attention, and not getting much credit for doing a good job. It’s always cleaning up everyone else’s messes, and never even asks for a raise. What are we to expect from this overworked civil servant?

Did you ever wonder why that when someone goes on a “liver detox”, or “cleanse”, they feel really crummy for a week or two? Sometimes they feel better afterward, but many do not, and there is a good reason for this. Just as there are phases of the moon, going from New to Full and back, and there are phases that teenagers go through where parents go from being heroes to being insufferable dorks, the liver has phases too. Unlike the moon, the phases of the liver are permanent. Consequently you will never hear expressions such as “once in a blue liver”, or a “waxing crescent liver”, or even the autumn “harvest liver”. And it’s a good thing too, because nobody would know what you are talking about.

Phases of the liver are basically 2 discrete sets of functions that the liver carries out independent of one another, and yet it’s their relationship to one another which determines, at least in the moment, if life feels like it is worth living. Phase I is akin to you taking the garbage out to the curb, and then Phase II is like the sanitation service hauling it away. When speaking of detoxifying the liver, it is important to keep these two phases in mind. During a supervised detoxification program, the individual’s liver function must first be evaluated, primarily by using a urinary evaluation.

There are several sets of patterns that emerge when making this kind of an evaluation: 1. Both phases are working well and harmoniously. 2. Phase I is working well, Phase II is not working well 3. Phase I is not working well, Phase II is working well 4. Neither are working well

So guess which one is the worst case scenario. It’s probably not what you think. The worst case scenario is one where Phase I is working well and Phase II is not. If you’ve ever been in New York City during a garbage strike, you will know what I’m talking about here. Especially if it was in the summer. So, the body brings this heavy load of garbage to the curb (Phase I), and then it sits there festering in the sun, smelling worse by the day, attracting flies. If it had been kept inside, it probably wouldn’t be as foul, but there it is, curbside, with nobody coming by to pick it up (Phase II).

So this is how it plays out: The body wants to get rid of a particular toxin, and pushes it through Phase I, which is an enzymatic transformation, in an attempt to make it easier to remove “nasties” from the body. In doing so, Phase I creates a whole new more toxic toxin out of it, for the sake of setting it up for phase II. So here you are with garbage ripening in the sun and you can’t do anything about because the garbage men are on strike. And so it is, those Phase I toxic rascals are much much MORE toxic than they started out to be, and the greater the build up, the more miserable you become.

So this is why your liver detoxification program needs to be aimed at Phase II before it deals with Phase I, so that when you start corralling toxins toward the liver, you don’t end up with all of this messy build up fermenting on the curb, to the irritation of your neighbors and dog walkers alike. When Phase II is dealt with first, it clears the way for Phase I toxins to clear out quickly without the ill effects. Now to me, that just makes good sense; to me anyway. So when going about “liver detoxification” the liver needs to be treated right, because we depend upon it. Then, life is worth living,

**Where does this symptom come from?

Asking questions like this can be thought of as radical. Really, it’s a very basic question that would seemingly be a common sense thing to ask of one’s self or one’s patient. Clearly, this is not the approach that modern medicine takes toward illness. A doctor should never fail to ask this question.

There is a fairly good reason for this. Modern medicine, built upon principles specific to an acute care model, has no use for this question. If someone is presenting to the ER doctor bleeding, so long as the knife or glass or bullet is not lodged in the body, the prime directive is to get the bleeding stopped, and appropriately so. The mechanism doesn’t really have an impact on treatment to a large extent.

When dealing with a chronic diseases and issues, utilizing an acute care model is doomed to eventual failure. This is because the fundamental question is never asked. If someone presents with headaches, depression, digestive complaints and huge hormonal swings, the typical medical response would be along the lines of the acute care model; which is sometimes necessary to get a hold on the situation, to stop the bleeding as it were. But more often than not, that is where treatment ends, and consequently the condition does not resolve, frequently worsens, and is further complicated by the treatments applied.

Using the acute care model is very familiar to us, for the above listed symptoms, the treatment would be something along the lines of:

Headaches: pain relievers/non-steroidal anti-inflammatories Depression: one of a variety of “anti-“ drugs Digestive complaints: antacid/proton pump inhibitor/antibiotic Hormonal dysregulation: hormone replacement or birth control pills

Again, in the short term, it is possible that this approach is necessary to get a foothold on the situation, and also in the case where too much damage has been done to the body for it to recover properly. But generally, as a long term strategy they don’t work because the fundamental question has never been asked: “Where does this symptom come from?” Headaches recur, anti-depressants stop working, digestive complaints return as soon as the medication is stopped, and the same can be said for hormones.

If we get back to basics and dare to ask this question of our doctors, most likely we are met with a blank stare, and the notion that it is not important what caused it, just that it is stopped by the treatment. (If indeed it is.) The response is as such because it’s a question that the majority of doctors of all disciplines were not taught to ask. But asking this question leads us to the cause, and once the cause is found, it can be dealt with.

There are many causes for each of the symptoms I mentioned earlier, but when they are put together they lead toward a smaller group of possibilities. How those symptoms are understood in the context of one another yields a lot of diagnostic fruit. When they are coupled with the proper standard and functional diagnostic laboratory testing and a thorough understanding of physiology, even the most difficult cases can be effectively treated.

In general, groups of symptoms which are not understood are called “syndromes”. However, when looking at syndromes, such as Chronic Fatigue Syndrome, doctors recognize a group of symptoms, but completely ignore many more that don’t “fit” the concept of what that particular syndrome is. Unfortunately what this means is that the diagnostic net has not been cast widely enough in order to take in all the factors contributing to the underlying problem. Thus the syndrome remains.

Unfortunately most doctors are not trained to thoroughly understand physiology (how the body works), just pathology (disease categories) and in a narrow range of specialization at that. So our fictional patient above will go to the headache doctor, the psychiatrist, a gastro-intestinal specialist, and an endocrinologist because each of the symptoms is thought to be an isolated entity unrelated to one another.

Understand however, that the body is a whole, and everything affects everything else. As an example, a patient presents with aching back and burning foot pain, a shifting of balance and posture, elevated blood pressure and cortisol (the stress hormone), systemic infection, loss of appetite, and inability to sleep. Imagine seeing a specialist for each of these symptoms! But this is what happens…all the time. What is required is someone to step back and ask: “Where did these symptoms come from?” It is only from that standpoint that we can begin to address chronic poly-systemic illnesses. If there is one who can understand the altered physiology and the interrelationship of these symptoms, then it is much easier to look at this patient and say, “All of your symptoms relate to this infected thorn in your foot.”

Functional Medicine doctors are at the forefront of asking the required questions, and making the connections between seemingly disparate aspects of our health problems. As common sense as it would seem to the lay person, it is a radical departure from the mainstream way of thinking, and is consequently marginalized to a degree. But the time is coming when this kind of doctor will emerge from relative obscurity into one that becomes everyone’s primary care doctor, freeing up the specialists to deal with the acute problems they have trained to properly handle. They are now, and increasingly will be the ones who answer this and other important but as of yet neglected questions. **

Weight gain, hair loss, chronic fatigue, difficulty thinking or maintaining attention, depression, constipation, loss of libido, muscle and joint aches, and fluid retention.

There may be many causes for any of these symptoms, but one common disorder is implicated time and again: Hypothyroidism. According to some studies, the prevalence in the U.S. of diagnosed hypothyroidism in women of any age is approximately 10%, and it’s quite likely that a great many more have not been diagnosed. While this issue also affects men, it is estimated to be at the much lower rate.

Recent studies have also shown that there are actually 24 different mechanisms which can impact thyroid or thyroid hormone function. These 24 mechanisms of thyroid related illness can symptomatically look and feel similar to, though not actually be diagnosed as hypothyroid. Because this discovery is relatively new, many of these mechanisms remain unrecognized in both traditional and alternative medical circles. These mechanisms include having elevated cortisol (the stress hormone), to deficiencies of brain chemicals such as serotonin and dopamine. Also, intestinal issues, sex hormone deficiencies or excesses, and elevated homocysteine can create thyroid related illnesses.

Shockingly, the literature indicates that greater than 90% of what is actually diagnosed as hypothyroidism in the U.S. is the result of something of which most doctors are not aware. So here’s the “earth is round” revelation: it is an autoimmune disease. There is currently an explosion of autoimmune disease in this country. An autoimmune disease is one in which the body attacks its own tissues; in this case, the thyroid. It goes by the name of Hashimoto’s disease. It is the most common autoimmune condition in this country, and entirely too frequently it goes undiagnosed. Here’s why:

Typically in suspected cases of hypothyroidism, only one laboratory test is looked at to make the diagnosis. That test evaluates how hard the pituitary gland (which is like an air-traffic controller for hormones) is working to stimulate the thyroid. The fewer hormones the thyroid is able to secrete, the greater the stimulation by the pituitary gland will be. The way the pituitary gland stimulates the thyroid is through another hormone called “Thyroid Stimulating Hormone” or TSH.

TSH will be elevated when the thyroid isn’t able to produce as much of its hormone. However, if that one test is within the “normal” range, the rest of the thyroid tests are generally never even looked at. In general, tests for autoimmunity to the thyroid are rarely checked. In Hashimoto’s, TSH may appear normal in the earlier stages. In intermediate stages, frequently, there are alternating periods of thyroid over- and under-activity. This is because the immune system attack breaks down thyroid tissue releasing hormones into the bloodstream. Because of the abundance of thyroid hormones, the pituitary gland stops the thyroid stimulation signal. Thus the test appears normal.

Unfortunately, typical treatment models fail to take into account the mechanism of action of thyroid related illnesses, including the most common cause of thyroid dysfunction, which really has nothing to do with the thyroid at all, but rather the immune system.

Backed by the latest research, new approaches in clinical practice offer promising methods for dealing with the 24 different patterns of thyroid related illness. This includes Hashimoto’s autoimmune thyroid. The approach taken in the field of “Functional Medicine” is to discern the pattern and it’s mechanism of action, and to deal with that mechanism accordingly. In Hashimoto’s and other autoimmune conditions, the current model is to mitigate the autoimmune attacks by influencing the activity of immune system signaling proteins called “cytokines”.

In the normal immune system, cytokines ramp up harmoniously to accomplish the task of killing invaders and establishing immunity. In autoimmunity, a small mutation of your own DNA lurking in the shadows can suddenly get its switch flipped on, and as the attack on self begins, one gang of cytokines becomes dominant while the other gang recedes. It is necessary to determine on an individual basis which gang is dominant and which has receded, because it appears that it is variable depending on individual genetic expression.

Utilizing specific nutritional biochemical compounds, the function of the different gangs of cytokines can be altered. The research has shown that by boosting the activity of one gang, it acts as a see-saw, putting the brakes on the other gang which has run wild. By using this particular approach, practitioners may be able to minimize damage caused by autoimmune conditions, thus slowing the progress of the disease; many times, dramatically.

Part of the Chronic Fatigue Syndrome/Chronic Fatigue Immune Deficiency Syndrome (CFS/CFIDS) problem is that there are few doctors out there who are able to identify and treat it. One patient said to me that her doctor was of the attitude that she should just “suck it up” and get on with life because, as he said, “you are as healthy as a horse, just stop being lazy”. And it is amazing to me that nearly every one of my patients who suffer with CFS, (myself included) have had similar experiences. Because these patients intuitively feel that something isn't right with their health, but have a difficult time finding someone to accurately assess their symptoms, they often have anxiety, depression, and anger issues by the time they find me, as well as chronic fatigue. It's common. And I understand why.

Because people suffering with Chronic Fatigue have usually been on extensive journeys in search of an accurate diagnosis and treatment plan, One of the questions I get, nearly on a daily basis, is: “How come my doctor, who is the best diagnostician/internist/rheumatologist/neurologist in the whole town/state/country/world said that there is nothing wrong with me, and YOU are finding things wrong with me in your testing?” In other words, "Why doesn't my other doctor know about this stuff?"

Typically, during my exams, the body's responses to biochemical, neurological, and sensory challenges tell me fairly accurately which processes in the body are compromised, and suggest some likely causes. This information is then usually corroborated and expanded upon when we follow up with some functional lab tests to assess things like liver function, GI health, etc. Usually, these things have been missed by traditional medical doctors. Not because they don't want to help patients, but, more likely, because they don't have the kind of training and tools that allow them to assess whole body function and often have little experience with treatment methods that fall out of the realm of "pharmaceuticals." That's just the way it is.

Most medical doctors are not trained beyond the small area of specialization they have chosen and simply do not receive a holistic education or training in the interrelationships of the body's systems. There's so much to learn about the body that becoming an educated holistic doctor truly requires a commitment to life-long learning after licensure. And, in a lot of circumstances, specialization in the medical field is a good thing, it's just not the end-all, be-all.

For example, I’m glad the oral surgeon knows how to pull teeth very accurately. It's an important thing to know how to do. I'm also glad the anesthesiologist is well-versed in the nuances of anesthesia -- it's pretty dangerous business putting people to sleep and waking them up again. Or, if my appendix bursts, I'm glad the surgeon can take care of me. The limitation of such specialization, though, is that, for example, a typical endocrinologist doesn't know much about neurology, and vise-versa. And knowing how endocrine function impacts neurological function and vice versa can save some patients a lot of grief when assessing complicated symptoms.

With chronic illnesses that have vast complexities, it takes time to unravel what exactly is going on. Plus, in typical medical practice, because of the way it is structured, the same medication may be given for a given condition despite the fact that it may have arisen from innumerable causes. While yes, it may have value for some, the problem is that the factors which caused the problem to begin with are still present, and being suppressed. Frequently this causes other problems down the road, in other systems of the body which seem unrelated. So the patient then goes to another specialist in that part of the body and the process continues, albeit in a different guise.

It turns out that the way most people, including doctors, have learned about the body is to go system by system, and they seem unrelated in the minds of the vast majority. But as some are becoming aware, all of these things work together. Consider this word: psychoneuroendoimmunology. That’s psychology, neurology, endocrinology, and immunology all stuck together. It’s a science, and it’s based in the interrelationships between those seemingly discrete systems. No divisions exist except in the mind.

So, with all of this complexity, how do we unravel this web? Fortunately, lab testing for CFS/CFIDS is getting better. While admittedly, there is no test specific for CFS/CFIDS, there are a lot of functional lab analyses that we can look at to help us diagnose this problem and find out the causes. As I’ve mentioned before, it isn’t a matter of finding the one cause of CFS/CFIDS, there is in almost all cases many causes. That’s why it’s called a syndrome, meaning a collection of symptoms that tend to look similar to other people who have them.

Mainstream medicine has some very fine tools. However, medicine is busy working on the reductionistic model of chronic disease, which means: “one cause, one cure”. As I mentioned, that is a fine way to work as it relates to traumas and acute symptoms, but in the world of chronic illness, it falls apart. There are no drugs to deal with the levels of cause, only symptom reduction. So if you are fatigued, take a drug to make you less tired. Sounds great, doesn’t it? Many people take this approach every morning by drinking coffee. But it doesn’t last, and worse, you get diminishing returns with this approach until the system completely fails.

Some are beginning to awaken to this very fact, so the the so-called alternative medicine CFS/CFIDS approach is then turned to as a model. Again, there are many fine treatment methodologies in the realm of alternative care. But, like medicine, the models of treatment begin to fail as the complexity of the chronic condition increases. In these cases, practitioners treat on the basis of “boosting immune system function” with herbs and supplements. It is a noble effort, but the immune system doesn’t really work as simply as that.

As an example, the question arises: “which part of the immune system are you enhancing, and WHY?” We need to know these things. We need to know these things because one of the many potential causes of CFS/CFIDS may be an autoimmune reaction or disease. Autoimmunity is by definition an immune response to one’s own tissue. So if you are enhancing “the immune system” in a wholesale fashion, and the person has an autoimmunity of some sort, doesn’t it seem at least possible that you will increase the efficiency of the body attacking itself? And if that is so, it isn’t a very good idea. Seems pretty logical to me. So we need to be very careful about which processes we wish to engage and enhance.

Fortunately, there is a small but increasingly potent contingent of doctors who transcend their respective fields, that share an interest and focus in the evolving field of “Functional Medicine”. Those of us who are pioneers in this field recognize the need for a comprehensive understanding of the vast web of inter-relationships between systems, and how to modulate those relationships in order to treat a patient on the proper basis and achieve optimal outcomes.

This art and science of practicing is what the doctors of the future are going to have to look like if we want to be able to gain any ground with CFS/CFIDS. There are no simple models or protocols, because while we are built similarly, we all have genetic and environmental uniquenesses which prevent us from achieving a one-size-fits-all approach. So what that means is that the doctors of the future have to truly understand all the facets of the web. Until this becomes widespread, our small group has a lot of heavy lifting to do for the whole profession in order to properly address those who seek our assistance.

Until next time…

So many exciting things are happening that it’s difficult to contain myself. New and promising natural approaches to thyroid disorders are revolutionizing how we look at problems with this organ. Having recently completed a comprehensive course specific to thyroid, hypothyroidism and Hashimoto’s Thyroiditis, I’m really excited about the implications of stabilizing thyroid function in relationship to hormone balance in general, and particularly with Chronic Fatigue Syndrome/Chronic Fatigue Immune Deficiency Syndrome (CFS/CFIDS).

It is quite amazing that this particular aspect of health is so thoroughly overlooked. It seems like the medical system would take thyroid disorders a little more seriously, given that nearly if not all cells of the body have places where thyroid hormones can attach and modify the activity of the cells. It is also astounding considering that the most prevalent autoimmune disorder in this country is Hashimoto’s Thyroiditis. Doctors frequently treat this condition in patients for years without knowing or even caring whether it is even there.

Why would they not care? Because, despite the fact that this is a disease which attacks the thyroid, it is treated exactly the same as if the person had an underactive thyroid, or low iodine, or poor conversion of the inactive form of thyroid hormone to the active form, or thyroid receptor insensitivity…or…any other thyroid disorder with the exception of a hyperactive thyroid (Grave’s Disease). How does this make any sense? Same treatment for different problems sounds like poor doctoring to me.

As it turns out, there are 24 variations of hypothyroidism and in medicine there is only ONE treatment! Fortunately in the world of functional medicine, each individual is evaluated specifically for the variation that is particular to them. Then, a treatment regime is formulated on that basis. It may or may not include the one medical treatment. That one medical treatment I’m referring to is either Levothyroxine, Armour, or Cytomel (or something resembling one of these). Great if you need it. Not so much if you don’t. Those of us who have been trained by Dr. Datis Kharrazian, author of “Why Do I Still Have Thyroid Symptoms…” have been educated all 24 of these variations and how to deal with each of them specifically.

How does this affect the fatigue of the CFS/CFIDS variety? Think about this, in order to produce energy each of your cells contain little organs that produce units of energy called ATP. One of the factors which activate the production of ATP is thyroid hormone. If thyroid hormone does not adequately stimulate the cell properly then guess what? The energy units of ATP don’t get made as quickly. Then you can become exhausted. Makes sense right?

Seems like it’s kind of important, to deal with the thyroid properly, isn’t it?