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Your early warning system

MagazineSeptember 2014 (Vol. 25 Issue 6)Your early warning system

Dr Sarah Myhill, who has spent 30 years studying the causes of most modern degenerative diseases, offers a blueprint of early symptoms to help you catch disease earlyFive years of medical school followed by a year of hospital jobs does little to prepare a doctor for the real world

Dr Sarah Myhill, who has spent 30 years studying the causes of most modern degenerative diseases, offers a blueprint of early symptoms to help you catch disease early

Five years of medical school followed by a year of hospital jobs does little to prepare a doctor for the real world. I had no answers to the questions raised by NHS General Practice patients: Why do I have high blood pressure? Why do I get such awful headaches? Why am I depressed?
The correct conventional answers to these questions are a 'deficiency' of, respectively, antihypertensive drugs, painkillers and antidepressants. But those aren't the true 'why' of the matter nor, indeed, even the 'what' of the matter. Masking symptoms does not explain them. The clues that symptoms represent have been missed and the investigative detective work, which should have resulted from those clues, has been left undone.
One year on from medical school, I was breastfeeding my daughter Ruth. She had terrible three-month colic and all I could do to lessen the screams was to walk round the house all night long with her in my arms. My husband Nick's reaction was, "You're the effing doctor-you sort it out." He was right. It was not until I stumbled across advice to give up all dairy that the problem was resolved. So too was my chronic sinusitis and rhinitis. At the time this was a momentous and life-changing discovery, but this information was nowhere to be found in the medical textbooks.
Doctors routinely confuse making the diagnosis with merely describing symptoms and clinical pictures-neither of which constitutes a diagnosis. Examples include hypertension, asthma, irritable bowel syndrome and arthritis, all of which are descriptions of symptoms and not actual diagnoses. Clinical pictures include Parkinson's disease, heart failure and Crohn's disease, but these are convenient titles simply to slot patients into symptom-relieving categories and do little to reverse the disease process or afford permanent cure. Symptom-relieving medication postpones the day when major organ failure happens. This is unsustainable medicine.

Thirty years later, this common cause and effect is still not found in those textbooks. I worried about not knowing causation. I had been trained to elicit clinical symptoms and signs and to recognize clinical pictures, but what patients really wanted to know was
why. What did they need to do to put things right?
The investigation of a patient is like a detective story-90 per cent of clues come from the patient's history and 10 per cent from the examination. Tests may confirm or refute the hypothesis, as every diagnosis is just an hypothesis. Once the diagnosis is further corroborated by test results, it still has to be put to the ultimate test: the response to treatment. Is the patient better? If not, the diagnosis is wrong.
My job is to teach my patients to heal themselves and supply them with the necessary tools to do so. The doctor should be the interface between hard science and the idiosyncratic patient-the practice of medicine is an art.
My early days in NHS General Practice were exciting. I learned to expect miracles as the norm. I watched a child's 'congenital' deafness resolve on a dairy-free diet; I saw patients with years of headaches see relief by cutting out gluten grains; I saw women with chronic cystitis gain relief by cutting yeast and sugar from their diets. A proper diagnosis establishing causation has obvious implications for management and the potential for cure. But what was so astonishing to me was that, when I tried to communicate my excitement and experiences to fellow doctors, they could not have been less interested and dismissed me as a 'flakey quack'!
I hope to empower people to heal themselves through addressing the root causes of their diseases by examining the symptoms, and identifying the underlying mechanisms and relevant interventions, tests and tools for tackling their symptoms.
What follows is my blueprint of early-warning symptoms, the end result of 30 years of trial and error.
I'll start with symptoms because they, and the desire to regain wellbeing, are what give people the strength to put in place the difficult dietary and lifestyle regimes to restore full health.

Symptoms: your early-warning system

Symptoms are desirable and therapeutic.
The best clinical clues come from symptoms, and 90 per cent of diagnoses come from the history.
The most common complaints heard by any doctor are pain and fatigue. These two symptoms are essential for protecting us from ourselves; they tell us what we can and cannot do. Without these warning symptoms we would keep going until we dropped because either our energy delivery ran out (stopping the heart and brain) or we would wear out (healing and repair occurs during sleep and rest). We ignore or suppress these symptoms at our peril.
Many other symptoms arise 'downstream' of these two symptoms because we ignore the early signs that pain and fatigue represent, or we interfere with or suppress them. Often, pathology arises as a result of this 'ignore, interfere and suppress' type of medicine.
Symptoms should always prompt us to ask one question: why?
Symptoms are often seen as part of the ageing process. This is because mitochondria, the engines of cells that generate energy, are also responsible for ageing. The numbers of mitochondria fall with age, so as we get older, we have to pace our activities. The body's ability to generate energy diminishes hand in hand with the falling numbers of mitochondria, so look after mitochondria and you will slow the ageing process.
Energy delivery is all about the collective function of mitochondria, the thyroid and adrenal glands, and the liver, gut, heart and lungs, along with the all-important diet. Together these are responsible for producing adenosine triphosphate (ATP).
ATP is the currency of body energy and a molecule of ATP can buy any job-from muscle contraction to a nerve impulse, from hormone synthesis to immune activity. Without ATP, none of these is possible. The difference between weak and strong, small and large muscles is the number of mitochondria.
Fatigue arises when energy demand exceeds energy delivery. This means there is a two-pronged approach to treating fatigue: improve energy-delivery systems; and identify mechanisms that waste energy.

Symptoms that arise from poor energy balance

Use the following checklists as a rule of thumb to work out where you are on the generalized fatigue scale.

With mild symptoms, you:
- Become an owl-it's hard to get up in the morning and you sleep in at weekends
- Start to use addictions to cope with fatigue-especially caffeine, sugar and refined carbohydrates
- Have to consciously pace activity-and look forward to rest time and sleep
- Dread Monday mornings if employed
- Lose the ability (or it becomes an effort) to enjoy yourself
- Treasure 'chill out' time in the evening
- Lose normal stamina-you fail to achieve normal levels of fitness
- Experience a decline in muscle strength
- Become irritable, mildly anxious and low in mood-imposed by the brain to prevent using energy frivolously, as having fun takes energy
- Feel mildly stressed-as the brain knows it lacks the energy reserves to deal with physical, emotional and mental demands
- Experience joint and muscle stiffness-if tissues are to move with minimal friction, they must be at just the right temperature; poor energy delivery means the body runs colder.

With severe symptoms, you will have:
Poor stamina. One molecule of ATP is converted to adenosine diphosphate (ADP) and recycled back to ATP via mitochondria every 10 seconds. When this recycling is slow, poor stamina (mental and physical) and muscle weakness quickly ensue.

Pain. If you run out of ATP because mitochondria can't keep up with demand, there's a switch to anaerobic (no oxygen) metabolism, which produces lactic acid. One molecule of glucose, burned aerobically (with oxygen) in mitochondria, can produce 32-36 molecules of ATP (depending on efficiency). Anaerobic production generates just two molecules of ATP plus one molecule of lactic acid, and clearing lactic acid takes six ATP molecules. This is a particular problem for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients, who lack the energy to clear lactic acid, so prolonging lactic acid burn. When this arises in the heart, the patient is said to have 'atypical chest pain', but it's actually angina.

Slow recovery from exertion and delayed fatigue.
As ATP is lost, the body uses another metabolic trick. Two molecules of ADP (two phosphates) combine to form one molecule of ATP (three phosphates) and one of AMP (one phosphate)-the 'adenylate kinase reaction'. The good news is there's another molecule of ATP; the bad news is that AMP is poorly recycled and leaves the system, forcing the body to make new ATP. This it can do from a sugar molecule, but it involves complex and time-consuming biochemistry-the 'pentose phosphate shunt'-resulting in delayed fatigue. This is the clinical picture of pathological fatigue (ME/CFS), when more severe tissue damage takes place at this point of very poor energy delivery.

Foggy brain. The brain is greatly demanding of energy; at rest, it consumes 20 per cent of the total energy generated by the body. Poor energy delivery results in brain fog, poor short-term memory, and difficulty multitasking and problem-solving.

Dizzy spells. These too are symptomatic of the brain running out of energy, and are commonly due to low blood pressure or sudden drops in blood sugar levels.

Very low mood and depression. ATP is not just the energy molecule; it's also a neurotransmitter. To be precise, it's a co-transmitter-neurotransmitters like dopamine, GABA, serotonin and acetylcholine don't work unless ATP is present. Mood disorders like anxiety and depression are much better treated if energy delivery issues are tackled.

Anxiety and severe stress. As sufferers know they lack the energy to deal with expected and unexpected demands, anxiety creates another vicious cycle because it kicks an emotional hole in the energy bucket and interferes with sleep.

Low cardiac output. The heart is a pump that also demands energy. If ATP is not freely available, it cannot pump properly, and weak beats result in poor circulation. The heart tries to compensate by beating faster, but this too is energy-demanding. Energy delivery can't keep up and blood pressure falls precipitously. Clinically this means severe ME/CFS patients can't stand up for long or sometimes even short periods of time, but often have to lie down. Rest is much more restful when lying down!
In addition, there's a vicious cycle here. Low cardiac output compounds all the above problems of poor energy delivery because of impaired fuel and oxygen delivery. So mitochondria slow down simply because they lack the raw materials to function well. (This is just one of the many vicious cycles of such conditions as ME/CFS.)

Intolerance of cold. No engine works with total efficiency. Some energy is always lost as heat, which helps keep us warm. Core temperature is often used to identify hypothyroidism, but it's actually a symptom of poor energy delivery, of which hypothyroidism is a part. Being cold results in another vicious cycle: enzymes need heat-roughly speaking, a 10-degree rise in temperature doubles their rate of reaction-but being cold means that mitochondrial, thyroid and adrenal enzymes, all essential for function, run slow.

Intolerance of heat. One method of heat control is to pump blood to the skin, the largest organ of the body. This increases cardiac output by 20 per cent, and explains why we all tire more quickly on hot days, but is unsustainable for severe ME/CFS patients.

Variable blurred vision. The eye muscles are energy-demanding, so if energy delivery is poor, ME/CFS patients are unable to contract eye muscles to focus the lens.

Light intolerance. The retina, weight for weight, is the most energy-demanding organ, consuming energy 100 times faster than the body itself. This is because the business of converting light to an electrical signal requires massive amounts of ATP.
Light intolerance is a feature of severe ME/CFS. It is also a feature of migraine, which may also have energy delivery as a possible cause. And energy cannot be generated without producing free radicals, which damage tissues. This may explain the high incidence of eye disorders with ageing, including cataracts, glaucoma and macular degeneration.

Noise intolerance. The business of converting air and bone vibrations to electrical signals that the brain can interpret is greatly demanding of energy.

Shortness of breath. If energy delivery at the cellular level is impaired, the brain may misinterpret this as poor oxygen delivery and stimulate the respiratory centre to breathe harder, resulting in hyperventilation and making the situation worse.
Hyperventilation changes blood pH so oxygen sticks more avidly to haemoglobin, worsening oxygen delivery. Shortness of breath may also result from heart failure, respiratory distress and anaemia.

Susceptibility to infection. The immune system is greatly demanding of energy and raw materials like zinc, vitamin C and selenium. A common cause of this symptom is hypochlorhydria (low stomach acid) because we need an acid stomach to absorb minerals.

Loss of libido. This makes perfect biological sense, as procreation and raising children require large amounts of energy.


What happens if you ignore or mask energy-balance symptoms?

Organ damage and organ failure are the result of ignoring or masking poor energy balance symptoms, so causing you to eventually develop the following conditions.

Heart failure. Symptoms usually come before organ damage, but not always. The kidney, for example, suffers in silence. If symptoms are ignored, then organ damage will result. Fatigue often arises when energy demand exceeds energy delivery; within cells, levels of the energy molecule ATP fall, and when they fall below a critical amount, that triggers cell apoptosis (cell suicide).
This is part of the ageing process-we literally lose cells and our organs slowly shrink. If the situation becomes critical because either total energy delivery fails or the number of cells declines, we develop organ failure and ultimately die. This is the process that stops us living forever.
A common organ failure that results in death is heart failure. Indeed, we are currently seeing an epidemic of heart failure, which I believe partly stems from the prescription of statins. One side-effect of statins is that they inhibit the body's production of coenzyme Q10, an essential cofactor for normal mitochondrial function.

Dementia. This is brain organ failure, which essentially arises when the speed of neural processing of electrical signals slows down-a process that is enormously demanding of energy. A major cause of dementia is arteriosclerosis, causing poor oxygen and fuel delivery to the brain.

Poor immunity. The immune system is enormously demanding of energy, which probably explains why elderly people are more likely to die of infections than younger people-they simply lack the energy to power their immune systems to fight infections effectively.

Do you experience pain?

Pain is the symptom that protects the body against damaging itself. Its function is to prevent further damage by resting the painful area so that healing and repair can happen.
Modest pain is essential for good health. The body is highly efficient-no energy resources are wasted. This has been essential for evolutionary success-we have to be intrinsically lazy. Pushing the system (which in nature occurs during predator-prey interactions) generates pain as a result of lactic acid burn together with mild wear and tear of muscles, connective tissues and joints. This modest pain is a powerful stimulus to lay down new tissue with a new complement of mitochondria, and this increases physical fitness.

Causes of pain

When taking a patient's history, I think of the mechanisms through which symptoms arise, as this has implications for treatment. The nature of the pain may provide useful clinical clues.

Mechanical.
In mechanical pain with tissue damage (which can also arise from inflammation), the sensitive coverings of organs are irritated. The pain of a broken bone comes from the membrane that covers the bone. The pain of an inflamed or ruptured gut (peritonitis) comes from the membrane that wraps round the gut. As the meninges covering the brain are highly sensitive, the pain of meningitis is severe. Lung membranes, when inflamed, cause the intense pain on breathing called 'pleurisy'. These pains ensure the patient is immobilized, as any movement makes things worse and is excruciatingly painful.

Muscle spasm in smooth muscle (the 'unconscious' muscle in the gut, womb, bladder). This produces some of the most severe pain, including labour pains, renal colic (from stones), gallstone colic (stones again), bowel colic from wind, constipation, adhesions and other blockages. These spasms are mechanically caused as muscles try to shift an obstruction. A feature of this pain is that movement is often helpful, making patients restless. The pain is colicky in that the severity waxes and wanes.

Muscle spasm in skeletal muscle. This is often extremely painful and often probably misdiagnosed as pinched-nerve pain. It often occurs following minor movement-not enough to cause damage. It starts suddenly and is described as lancinating or stabbing, knife-like, sharp or like an electric shock. The sufferer is completely floored. After a few minutes it settles, but any awkward movement may provoke it again. Cramping, stiff neck and stiff-person syndrome are examples of acute muscle spasm, which may be due to allergic muscles, mineral imbalances, dehydration or acidity.

Lactic acid burn due to poor energy delivery. The switch to anaerobic metabolism comes with the production of lactic acid, which causes pain. It starts as a dull ache but, when not relieved, grows into the severe pain of a myocardial infarction requiring morphine for relief. Athletes experience this daily, and it both allows and limits peak performance-no pain, no gain! Lactic acid burn in the heart is angina, the recurring pain that comes with exercise and is only relieved by rest.
In patients with very poor energy delivery (such as ME/CFS), the lactic acid burn may be persistent. The best examples are ME/CFS patients who develop chest pain-actually angina-which is not due to poor blood supply, but poor mitochondrial function. Acute, unremitting lactic acid burn due to arterial obstruction causes severe pain like a heart attack, pulmonary blood clot or acute arterial obstruction. Again, the pain of migraine may have to do with poor energy delivery to the brain.

Muscle and joint stiffness. This is a common but greatly overlooked cause of discomfort. When tissues don't interact smoothly, the resulting friction leads to stiffness as the body tries to protect itself against sudden movements. The patient has to 'warm up' slowly before attempting to move. Inflammation may cause this and perhaps a mineral imbalance too, as so many patients respond well to topical magnesium applied to the skin. There is also an allergic component.

Inflammation. This is nearly always painful, although mild inflammation may present with itching. Inflammation is characterized by pain, swelling (with the potential for mechanical irritation), heat, redness (due to increased blood flow) and loss of function (as the body protects itself by shutting down that region). Inflammation-including that due to silicone implants-is often described as burning pain that is often worse in the morning and improves as the day progresses.
Throbbing is another feature of inflammation. Increased pressure makes the pain worse, and someone with severe toothache or sinusitis finds the symptoms are worse lying down. Symptoms of inflammation may be reduced by cooling and worsened
by heat.

Inflammatory pain at rest (for instance, at night). I suspect this is the pain of healing and repair, which cannot take place unless the organ is resting and shut down. Healing and repair involves inflammation.

Nerve pain. This can be electric-shock-like and markedly dependent on position or movement. Anyone who has banged the 'funny bone' (the ulnar nerve at the elbow) will recognize this. The pain follows the area that the nerve supplies, so careful mapping of the pain provides useful anatomical clues. Sciatica typically starts in the buttock and radiates down the back of the leg. Carpal tunnel syndrome involves the thumb, and index, middle and part of the ring fingers, sparing the little finger. It may arise because the nerve is pinched, which may be a mechanical problem or because of swelling of soft tissues due to inflammation or myxoedema. Tic douloureaux, I suspect, is due to allergic nerves.

Malaise.
Many patients struggle to explain this feeling of not being well. I suspect it reflects low-grade tissue damage and poor energy delivery, resulting in low-grade inflammation that may not show up in standard blood tests, but may be reflected in a cell-free DNA (CFD) test, a simple blood test that detects cell damage based on CFD values on microscopy.
Malaise is very common in ME/CFS patients who cannot pace their energy output for basic 'housekeeping' duties (such as gut, liver, kidney, heart and brain function). Some products of inflammation have a direct impact on the brain, resulting in 'illness behaviour', again as a protective mechanism to allow rest to protect one from oneself.

Toxic emotions
All pain is perceived as more severe in the presence of fear, anxiety, depression and loss of hope-the mental and emotional state is critical. The key to treating pain is not to mask it with painkillers, but to ask why it arises before the clinical picture becomes blurred. Once pain has become longstanding and chronic, many of the above mechanisms come into play, making it more difficult to tease out what really needs tackling. Other vicious cycles also then cut in.

Do you have symptoms of inflammation?
Inflammation is characterized by the cardinal symptoms of pain, swelling, heat (redness) and loss of function. We all know the obvious source-infection-but allergy and autoimmunity also result in inflammation and can cause almost any symptom.
The living organisms that we are potentially represent a free lunch for others. We fight a constant 'arms race' against invading microbes and parasites. It could be argued that all disease processes involving inflammation are part of this arms race.
Many occasional symptoms can physically expel or kill invaders. The same disease processes are invoked in allergy. Acute symptoms are most likely infectious, while chronic or recurring symptoms are allergic and/or autoimmune. So, looking at a hay fever sufferer with no clinical details, one might diagnose a cold. Looking at an inflamed patch of skin with no clinical details, one would have to consider allergic eczema, sunburn, a chemical burn, infected cellulitis, or a viral or autoimmune rash.

Symptoms of acute inflammation
- Fatigue-an essential symptom to enforce rest and give the immune system the energy it needs to fight
- Malaise and 'illness behaviour'-men seem much better at this than women
- Fever-most microbes are killed by heat
- Mucus and catarrh-this physically washes microbes away
- Runny eyes-ditto
- Coughing and sneezing-physically blasts microbes out of the airways
- Airways narrowing, wheezing, asthma-as the air we breathe becomes more turbulent, microbes are thrown against and stick to the mucous lining of the airways, and are coughed up or swallowed
- Vomiting-an essential defence mechanism against food poisoning and microbes inhaled (which are coughed up or swallowed)
- Diarrhoea-ditto
- Colic-ditto
- Cystitis-emptying the bladder of urine also gets rid of microbes.

Do you have chronic symptoms?

If yes, you should consider allergies, intolerances or autoimmune issues. Allergy is today's great mimic and can produce any symptom, including all of those listed here. It's also possible to be allergic to anything under the sun-including the sun. When considering allergic problems, there are groups of allergens which may be causes:

Foods and food additives
like wheat, dairy and the other big allergens, or common additives like food colourings

Biological inhalants, such as house dust mite, pollen, animal dander and moulds

Chemicals like toxic metals, pesticides and volatile organic compounds (VOCs), including perfumes

Gut microbes, such as yeast, bacteria, parasites, worms and possibly others.
The above sensitivities may be worsened by other proinflammatory or irritant factors.

Electromagnetic radiation. Electrical sensitivity is a real and growing problem with adverse reactions to mobile-phone masts, Wi-Fi, computers, TVs and the like. The mechanism appears to be the activation of voltage-gated calcium channels, making membranes more easily irritated.

Noise pollution and infrasound
. Wind-turbine syndrome is a genuine condition with additional problems due to amplitude modulation. The mechanism of damage is twofold: first, sleep deprivation; and second, infrasound sets up resonant frequencies within body cavities, causing disturbing symptoms of headache, unease, agitation, vibrations, vertigo and gut disturbances.

The 12 most common symptoms of allergy
While any antigen can cause any symptoms (Dr John Mansfield described a case of hip osteoarthritis due to allergy to house dust mite), common things are common causes. Chronologically, symptoms often start in the nose and throat, then extend to the gut and brain, followed by any other organ. If a symptom has become chronic, consider the following allergens (in order of likelihood):

ENT symptoms like catarrh, deafness, glue ear, snoring and obstructive sleep apnoea, voice changes, cough: allergy to dairy products, yeast (fermenting gut)

Tinnitus: allergy to food or gut microbes (this may also contribute to age-related deafness-Beethoven went deaf following Salmonella infection), while caffeine may cause tinnitus as a toxic reaction

Irritable bowel syndrome: allergy to foods and upper fermenting gut problems

Inflammatory bowel disease: allergy to foods and upper fermenting gut problems

Asthma: allergy to food, biological inhalants and gut microbes

Headache: aspartame, dairy and caffeine may cause toxic headache; migraine is a typical allergic headache, but there are other causes, such as poor energy delivery and toxic reactions from vasoactive amines

Eczema, urticaria: allergy to foods and gut microbes

Acne, rosacea:
allergy to gut microbes and foods

Interstitial cystitis, chronic prostatitis/epididymitis/vulvitis: allergy to gut microbes, especially yeast

Arthritis: allergy to foods and gut microbes

Allergic muscles, tendons, connective tissues: allergy to dairy, gluten and gut microbes

Fatigue: allergy to gluten in grains.

Do you have symptoms of toxicity?
These usually include head/foggy-brain symptoms, depression and even psychosis. Humans have evolved a fabulous detoxification system in the gut, liver and bloodstream to cope with toxins. But we are now all inevitably exposed to more toxins from the outside world because of pollution. I have yet to do a fat biopsy or test for toxic metals and find a normal result. Many of these toxins cause problems because they may:

inhibit energy delivery systems (with all the accompanying symptoms)

act as adjuvants to trigger allergies to other substances, the basis of vaccination; there may be proinflammatory effects from toxic metals (in vaccines), organophosphates and diesel particulates (triggers for pollen sensitivity)

act as an antigen and trigger allergy to itself (nickel allergy)

block hormone systems: our epidemic of type 2 diabetes may partly result from blocked hormone receptor with insulin resistance; bromides, fluorides and toxic metals inhibit thyroid hormone receptors

act as hormone mimics (organochlorines have oestrogen-like effects; they can change the gender of crocodiles)

switch on cancer (toxic metals, pesticides, VOCs)

trigger prion disorders (toxic metals and organophosphates).

Direct toxins
Some toxins are directly toxic. The most common manifestations of direct toxic stress are seen in the brain.

Alcohol-after drinking the stuff, we all feel poisoned with a hangover

Caffeine-too much is toxic

Prescription medications

Drugs of addiction

Sugar and refined carbohydrates resulting in fermenting gut-this too may produce hangover-like symptoms

Fermenting brain. Professor Katsunari Nishihara's idea is that microbes, probably from the gut and/or the outside world, enter the brain and ferment neurotransmitters into amphetamine- and LSD-like chemicals. Clinically this would lead to a vast range of psychiatric and psychological symptoms.
As a doctor who spends her life talking to patients, I'm good at spotting patterns and identifying underlying mechanisms that have resulted in the clinical picture in front of me. But everyone is an expert when it comes to their own bodies and minds and, given the right clues, we can all work out these mechanisms ourselves.

Preventing disease

The greatest modern health hazard is the metabolic syndrome (MetS), a constellation of features resulting from Western diets and lifestyles. It's easy to diagnose-simply look into a supermarket trolley; if it's largely composed of bread, cereals, biscuits, pasta, fruits, crisps, sweets, chocolate and alcohol, then MetS is present. The early symptoms include having to eat regularly, not being satisfied with a meat and vegetable meal until a sweet pudding is eaten, snacking regularly and eating or drinking to relieve stress. Fatigue, mood swings and insomnia follow.
Doctors get involved only when these apple-shaped people are found to have high blood pressure and high cholesterol, followed by an inevitable progression to diabetes, heart disease and cancer. We now know arthritis and osteoporosis are long-term effects of MetS-and Alzheimer's disease too, recently renamed type 3 diabetes.
Most doctors have no grasp of the above progression. They fail to appreciate that carbohydrates are eaten addictively. The intellectually risible 'food pyramid' (which places carbohydrates at the bottom as staples, with meat and eggs at the top as occasional extras) is evolutionarily incorrect and
upside-down.
As we can no longer rely on the medical profession to guide us to a healthy lifestyle, we must do it ourselves. This can only be achieved by a true understanding of the underlying mechanisms by which Western diets and lifestyles impact health and create disease.
Initially we have to identify and correct those aspects of modern Western lifestyles that are so damaging to health. The big issues are diet and nutrition, sleep, exercise, pollution and infections. Ideally, we should put all interventions in place before symptoms appear and before they trigger pathology. I call these eight measures the Basic Package, which should be applied in all cases, regardless of the current state of health of the individual concerned.
Dr Sarah Myhill
Next month: the most important tests and treatments

Dr Myhill's Basic Package
Ideally, we need to take control of our health before symptoms appear. Here are Dr Myhill's eight ways to live a long and healthy life.

1 Follow a Stone Age diet (staples: meat, fish, eggs, vegetables, nuts, seeds, salad, berries; occasional treats: dairy, grains, fruit)
2 Take multivitamins, minerals and essential fatty acids
3 Get a good night's sleep
4 Exercise
5 Get enough sunshine
6 Reduce yourchemical burden
7 Get sufficient physical and mental security to satisfy the universal need to love and care, and be loved and cared for
8 Avoid infections and aggressive treatment
Dr Sarah Myhill is a British GP and author who has spent many years studying the causes of disease, especially the relationship between mitochondrial malfunction and fatigue.


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