Monday, October 21, 2013

Are you thriving or just surviving? My thought process behind assessing overall health.

When I first sit down with clients, I try to get a feel of what is going on in their life.  Whether the client is there to lose some weight, improve pain, or just feel better overall, I find it useful to get an overall picture of how their health is doing compared to what I consider ideal.  With most of the clients I see, I break the body down in to 3 primary systems; metabolic, adrenal/stress, and digestive and try to determine where people are doing things that can muck these systems up.  This process helps me determine the right protocol to help each person achieve their goals.  Below is my thought process in assessing each system.


Before I delve in to people's lifestyle, it is important to get an idea of which medications they are taking.  Not only will this give me an idea of which systems are failing, but it also tells me a lot about what I am likely to find going further and helps direct my line of questioning.  This is a very important step as it begins to establish buy-in with the client.  Most people are still stuck in the genetic determinism mindset where they believe their genes pretty much determine their health.  Sure, they may believe that lifestyle changes can help a little bit, but for the most part they believe they need their medication.  That is not to say that medicine isn't necessary, under certain situations it is a life saver.  However, I find them overused when taken chronically to regulate something like blood pressure and/or blood glucose.  Below is a sample line of questioning I may use with a client during an initial assessment.

"So you take metformin to help regulate your blood sugar, and your fasting glucose is normally between 100-120.  Would you consider your job stressful or do you feel anxious at times?  Would you say you have no trouble falling asleep and get a good 8 hours of sleep every night?  Are you having any troubles with digestion?"
Normally, people are on multiple medications which pretty much drives the questioning as to which systems are failing.  What could they be doing in their everyday life that would give them anxiety?  Do they get enough regular physical activity?  Are they even attempting to manage their stress?  Are the foods they're eating right for them?  Most people take 1 medicine for every decade they've been alive, so when I get a 45 year old woman who's taking 4 medications, I get a pretty clear picture of where I have to go simply from asking them about the medicine they take.  When you can direct your line of questioning in a way that makes the client go, "How did you know that?", they start drinking the sugar-free Kool-aid and begin to believe that a lifestyle intervention will help.

Metabolic System

When assessing the metabolic system, I look at 3 primary things: blood glucose, appetite, and energy levels.  I like to see fasting blood glucose around 90mg/dL, no snacking between meals, and constant energy levels.  In addition, if they are willing to test, I like to see blood glucose remain below 130mg/dL 1 hour after a meal and back to fasting within 2-3 hours.  Normally I see people whose fasting glucose is over 100mg/dL and need to eat every 3 hours or they feel an energy crash.  This is indicative of being broken metabolically and requires significant lifestyle change.  It also tends to mean their digestive barrier is compromised and as a result their adrenal/stress system is thrown out of whack.

Typical signs and symptoms of a broken metabolic system: Uneven energy levels, feeling tired after meals high in carbohydrate, irritability, anxiety, poor sleep, profuse sweating, high blood glucose, never feeling full after meals.

Adrenal/Stress System

We all experience stress on an ongoing basis.  When you combine what goes on in your life with what goes on in your job, we are pretty much bombarded by stress 24/7.  Our adrenal system is not meant to be under a constant barrage of stress, we are meant to experience stress and then have it resolved relatively quickly.  Like it or not, this is the world we live in so we need tools to manage it.  Probably the best way to manage stress is to take it head on.  Rather than letting things fester until the last minute, resolve as much stress as you can right away.  If you forget to pay bills, sign up for autopay and have them taken directly out of your bank account on the day you get paid.  If you need to arrange a ride for your daughter because you have to work late, take care of that immediately.  These things sound pretty self-explanatory, but most people who have problems with this kind of stuff just don't do them.

Another thing that helps regulate the adrenal system is physical activity and exercise.  If you wake up every day, take a 30 minute commute to work, get to your desk and sit for 8 hours, then go home and sit down and watch TV, you have caged animal disease.  Caged animal disease is a term I made up for what you typically see in high energy dogs who are kept in their cage all day long.  When they get out they go nuts and tear through the house.  Humans, like dogs, need lots of physical activity, and when they aren't getting it the first place it shows up is in higher levels of stress and anxiety.  This will also affect their ability to sleep, their digestion, and their metabolism.  Most people's exercise program should be predominantly walking, a little strength training, and some form of relaxation exercise such as stretching, yoga, tai chi, or meditation.

Typical signs and symptoms of a broken adrenal/stress system: Poorly regulated blood glucose(High or low), an inability to concentrate, poor digestion, joint pain, poor sleep, feeling wired but tired, low energy, anxiety/depression, relying on coffee for am energy, feeling tired when awaking but wide awake when trying to fall asleep at night..

Digestive/Immune System

Most people don't associate their immune system with their digestive system, but 80% of your immune system is housed in your gut.  Since your gut is the primary barrier through which the outside environment communicates with your internal environment, this is the best place for your immune system to reside.  The problem is, since your immune system is housed in your gut, eating things that aren't right for you can cause major problems with nearly every aspect of your life.

The digestive system is so important that regardless of what I find elsewhere during the assessment, treatment begins in the gut.  In order to have a properly working metabolic or adrenal system, you need the nutrients that these systems run on to make it in to the bloodstream.  If you have a compromised gut, this doesn't happen.  You may be eating all of the nutrients you need, but if they don't enter the blood they don't do their job.  This is why I am a big pusher of the Paleo diet.  Not only is it high in nutrients, it's also high in prebiotics that help maintain a healthy gut.  In certain situations the Paleo diet isn't enough and people with major digestive problems may need to try a specific carbohydrate or GAPS diet.

Typical signs and symptoms of a broken digestive/immune system: Gas/bloating, poor sleep, anxiety/depression, poor energy, high blood glucose, increased appetite, skin conditions, headaches, food intolerances, allergies, constipation, diarrhea.


As you can tell by the common signs and symptoms, there is a lot of overlap between these systems.  In addition, other systems such as the neuromuscular and detoxification system can also be involved.  This is because each system doesn't act in a vacuum, they are all dependent on the other systems doing their job.  In some instances you can find a clear smoking gun, but in most cases there is typically a few things going on that contribute to poor health.  One thing that I am sure to make clear up front is that positive outcomes are not going to be quick.  Most people like the idea of being able to take a little pill and have their problem resolved within a few hours or days.  The problem is, that pill typically isn't solving the problem.  Typically, they simply mask a symptom that is telling you that one of these 3 systems, or another, isn't working properly.  For optimal health, your best bet is to fix the system rather than mask the symptom.