Health is not a static state. It is a dynamic, ever changing balancing act. There is a flux of multiple forces and influences that affect our health. To assess the balance of forces affecting a person’s health we must evaluate the Determinants of Health.
All disease states are generated by disturbances in the Determinants of Health. On a day-to-day basis, most of the disturbances in the Determinants are compensated for without overt signs and symptoms. When symptoms or signs do develop, they are indicative of the organism’s compensatory responses to disturbances in the Determinants of Health. Regular, prolonged and/or multiple disturbances will generate more overt signs and symptoms. If the underlying disturbances are not corrected, the compensatory reactions will become chronic and lead to degeneration of tissues and organs. We must correct the underlying disturbances in the Determinants in order to create a return to health. Moving backwards through this cycle could create an acute reaction and discharge as the body eliminates some of its toxic burden. This is a good sign because it indicates the resiliency, responsiveness and vitality needed to regain health. Many of the Determinants of Health can be affected by the choices we make in our lives, but some we are powerless to affect. This is true of the first two Determinants that will be discussed.
Inborn Determinants of Health encompass not just our unique genetic make-up, but how the environment in which we lived during our time spent in utero and as an infant affect the expression of our unique genetic make-up. At this stage of life our mothers’ and fathers’ health, nutrition, and lifestyle play a large role in our development. An in depth knowledge of our inborn genetic traits allow us to be cognizant of the potential susceptibilities we may have to certain types of disease states. This is why naturopathic doctors collect such a thorough family history and ask about prenatal and natal development.
It is critical to assess these inborn Determinants such as genetics and early life exposures as they give us insight into the unique ways they interact with other Determinants. A good example of this would be our genetic inheritance of ABO serotyping and the relationship our blood type has with nutrition and digestion.
History of Disturbances
Our past experiences have a profound impact on our current state of health. The physical and emotional exposures, stresses and traumas we have experienced in the past cause our bodies to develop specific patterns and methods to deal with the situations we encounter in our current life. Past medical interventions and illnesses, past exposures to toxic and harmful substances, and unresolved emotional dissonance around past relationships affect the way in which we experience health moving forward into the future.
Breathing is something we each do unconsciously every moment of our lives. It is one of the defining aspects of being alive. Each cell in our body requires the fresh oxygen that our breath provides to function properly. Equally important, our cells rely on our outgoing breath to eliminate waste products and toxins. When someone’s breathing ability is compromised, such as in asthma, pneumonia, or emphysema, we can quickly see the destructive effects this has on our health. Although most individuals thankfully do not develop these dramatic impairments, few engage in optimal breathing patterns. In order to fully perfuse our tissues with oxygen and carry away waste products, it is critical to practice abdominal breathing, in which slow, deep breaths through the nose utilize the entire expansive capacity of our abdominal diaphragm. Ideally, deep abdominal breathing should be practiced with every breath we take, but setting aside specific times each day to practice abdominal breathing will still greatly benefit our health.
Water is another essential determinant of our health. Over 98% of the molecules in the human body are water. It performs a myriad of essential functions in our body from lubricating our cells and tissues to supporting each organ system, both by strengthening function and improving waste elimination. Research shows that optimal kidney function occurs with 1 pint of water consumption every waking hour. At a very minimum, healthy individuals should consume at least half of their body weight in ounces of water daily. For people suffering from chronic or acute illness, recommendations for daily water intake increase substantially. We must also account for substances and activities that further increase our water intake requirements, such as the use of diuretics (coffee, alcohol) and vigorous exercise.
Sleep is a fundamentally basic determinant of health. The typical person spends one third of their entire life sleeping. Our bodies are actually incredibly active during sleep, particularly the brain. During sleep the brain sorts and catalogues our thoughts from the previous day and cleans out all the metabolic waste products that have accumulated. At the cellular and tissue level we undergo a vigorous process of repair and renewal during this very important time. Disturbances in the length or continuity of sleep have a strongly detrimental effect on these processes. This is why naturopathic doctors are so inquisitive about quality of sleep and why they actively work to correct disturbances to this essential determinant of health.
Nutrition, or the food we consume, constitutes the molecular building blocks of each cell, tissue, and organ in our bodies. There is a direct relationship between the types of foods we eat and the quality of the foods we eat, and our state of health. The quality of a food includes everything from the nutrient composition of the soil it was grown in, to the methods that were used to cultivate, harvest, and transport it, to the way in which it was prepared for consumption. Just as the structural integrity of a building depends on the type and quality of the materials it is constructed from, so to does the health of our cells and tissues depend on the type and quality of the foods we consume. Because we are genetically unique, the types of foods our bodies can most efficiently extract nutrients from varies from person to person. I have found that knowing one’s ABO blood type, and to an even more specific degree, one’s Genotype, provides invaluable insight as to which foods have potential to build our health and which foods have the potential to erode it.
Digestion, or the process through which we break down and assimilate the food we consume, plays an enormous role in our health. The state of our digestive function not only determines our ability to extract and assimilate nutrients from the food we consume, but also dramatically influences the function of our immune system, over 80% of which is located in the digestive tract. Disturbances in digestion can arise from a myriad of causes, including genetic predisposition, consumption of incompatible foods, exposure to drugs and toxins, infections, and chronic stress to name a few. In my clinical experience, I have found disturbances in digestion to be the single greatest contributor to compromised health. For this reason I exert great effort in understanding each person’s digestive function and addressing any identifiable disturbances using natural medicines, therapies, and techniques.
Another central aspect of digestion is the state of eliminatory function. Many waste products and toxins are eliminated through the stool, including innumerable compounds our liver detoxifies and secretes as bile into the digestive tract. When elimination is disturbed, as is the case in constipation, toxins and waste products are reabsorbed into our bloodstream, leading to many potential adverse health impacts. Well-formed, daily bowel movements are essential for maintaining adequate elimination of the digestive tract.
Mental, Emotional and Spiritual Determinants
Our mental, emotional, and spiritual state of being affects our health profoundly. The dictates of the mind are powerfully and closely linked to the physical expressions of the body. Well-documented research has found happiness to be a stronger indicator of extended longevity than any other predictor of health. Perhaps the greatest influencer of these determinants lies in the relationships we cultivate between each other. A nurturing relationship fosters positive mental and emotional health, while toxic relationships poison our mental and emotional health.
Whether consciously or subconsciously, our greatest need is for a sense of purpose and meaning in life. We fulfill this need through a multitude of avenues: organized religion and other forms of spirituality, career paths, family life, recreational activities, connection to other humans, to nature, to places or objects, etc. When our ability to satisfy this need for purpose and meaning is disturbed, our mental and emotional health, and therefore our health in general, is made vulnerable.
Stress is a concept that is closely related to mental and emotional health, which has large determining force on health. Stress begins in the mind as a reaction to a perceived threat or disharmony in our surroundings. The stress response triggers a host of physiological processes, which can be very useful in acute, isolated events. Yet when the stress response is evoked chronically, it causes great harm to our health over time. The presence of chronic stressful states is ubiquitous in our modern society. As naturopathic doctors, we seek to help individuals identify stressors and eliminate them from their daily lives if possible. When we cannot remove a stressor, then we employ techniques that help individuals adapt the way their mind and body react to stressors.
Physical activity is a core determinant of health. When we move our bodies we activate many beneficial physiologic processes. Our connective tissues, muscles and bones become stronger, our metabolism becomes more efficient, our mind and nervous system are put in a state of ease, our immune function is enhanced, and our circulation improves, bringing nutrients to our cells while simultaneously removing toxins and waste products. For our human ancestors, physical activity comprised the majority of their waking hours as they foraged and hunted food for typically 6-8 hours daily. With modern society’s sedentary tendencies, the average person spends less than 30 minutes per day engaged in physical activity, setting the stage for disturbances in the many intrinsic physiological processes our bodies rely on. Committing to one hour of exercise or movement on a daily basis will improve our health as much or more than any other single therapy modern medicine can employ.
As naturopathic doctors, we teach several other simple, highly effective home practices that improve circulation and the many health benefits that come with it. Hydrotherapy, or the alternating application of hot and cold water to the skin dramatically improves circulation when done on a regular basis. One can simply incorporate hydrotherapy into their daily routine by ending showers with a cold rinse, bringing the stream up each extremity, then around the torso, and finishing with immersion of the head. Many varieties of hydrotherapy can be incorporated depending on each person’s unique health situation.
We exist in a dynamic relationship with the earth we live on. The qualities of the physical space we occupy undoubtedly influence our health. An individual living in New York City experiences life in a very different manner than someone living in remote wilderness. The relationship between physical environment and our health is a fascinating emerging field of research. For example, earthing, or walking barefoot in nature, has been shown to lower stress hormone levels, decrease blood pressure, and improve sleep. Sunlight exposure, aside from its critical role in the body’s synthesis of vitamin D, plays a large role in hormone regulation and healthy balance of sleep-wake cycles. The air we breathe is essential for health but can also poison health when contaminated with toxic compounds generated by the industrialized cities we live in. Connection to the natural world is fundamental to our human nature. Whether it is basking in the sunshine, enjoying a stroll through the forests or mountains, or dipping into clean freshwater lake, we should each strive to engage with nature on a daily basis.
Epidemiological studies have resoundingly concluded that an individual’s social conditions play a large determining role in their health. Education level, cultural heritage, economic status, and access to health care have a huge influence on our health. Some aspects of these social structures are modifiable by the decisions we individually make, but in many cases they are not. As doctors and patients, we must be aware of these important influencers as they uniquely relate to each individual and consider them within the context of one’s larger health picture.