Multi-System Disease (MSD)

A New Paradigm
I propose the use of the term "Multi-System Disease" (MSD) to describe a family of clinical syndromes that share similar underlying dysfunctions of the body. These clinical syndromes would include such diseases as endometriosis, fibromyalgia, chronic fatigue, food and environmental sensitivities, some cases of interstitial cystitis, insulin resistance, hypothyroidism, allergies and autoimmune diseases, Lyme disease and associated infections, to name a few. Genetic and environmental factors typically contribute to the specific clinical syndrome expressed.

This concept involves a paradigm shift in how we view health and disease, and is a unifying theory for seemingly diverse diseases. In Western medicine, we traditionally think of disease largely as one disease with one symptom, resulting from one metabolic defect that is best treated by one pharmaceutical agent. For just this reason, traditional Western medicine is often ill equipped for the diagnosis and treatment of MSD.

The concept of Multi-System Disease is one of process rather than specific cause and effect. There is an initial trigger that starts the decline in health; then compounding factors follow, intensifying the process.

The Process
The human body has a wonderfully complex inter-relationship of organ systems. The body acts as a buffer system, processing and eliminating both internal and external factors. MSD describes an overall decrease in the functionality of multiple organ systems, resulting in an overall decline in health and functionality of the person as a whole.

The initial agent, or "insult" that starts the process, can be any one of countless possibilities; but it is one that chronically stresses the body's buffering capacity. Over time, additional factors accumulate, adding an increasingly large burden on the buffering capacity of the body. This is much like adding straws to the camel's back until it finally breaks.

The different organ systems which can be involved include the endocrine system (this includes all of the various hormones released by the body – estrogen, progesterone, androgens, thyroid, growth and the stress hormone cortisol), the nervous system, including the autonomic nervous system with the sympathetic and parasympathetic nervous system (including the hypothalamic-pituitary-adrenal axis), many aspects of the immune system, and possibly even the coagulation system.

In its most severe form, this disease process results in virtually a complete decompensation of almost all of the vital organ systems, and thus the decompensation of the overall health of the patient. He or she can be left in a state of such low body function that performing even routine functions becomes nearly impossible.

Multi-Disciplinary Approach
The global but subtle nature of this disease process makes it difficult to both diagnose and treat. Our lack of understanding of the specifics of MSD, and the lack of sensitivity of our medical tests, adds to the difficulty in diagnosis. The comprehensive nature of this disease process also requires knowledge in a wide range of medical conditions, traditionally traversing multiple medical specialties. Treating one aspect or dysfunctioning organ system of MSD is rarely enough to see a clinical difference in the patient. Thus, the persistent treatment of multiple organ systems over time is needed prior to seeing a clinical improvement in the patient. I, also, believe that both traditional and alternative medicine is often needed for the successful diagnosis and treatment of MSD.

Genetic Polymorphism
Simply put, genetic polymorphism refers to changes in our genes resulting from coding errors. A significant aspect of normal body function involves biochemical reactions. One or more substances are modified, forming a new product – such as estrogen – through a biochemical reaction. Enzymes and cofactors are essential ingredients necessary for a biochemical reaction to occur. We are beginning to understand that polymorphism of different enzymes and/of cofactors is one reason patients develop chronic disease and MSD.

Polymorphism is characterized by a subtle change in the structure of the protein that makes up the enzyme or cofactor. A person's genetic code instructs his or her body as to which amino acids to use, and the order in which to place them when making a protein. A protein is comprised of a string of amino acids. The body uses approximately 20 different amino acids; about half of these are known as essential amino acids, which the body cannot manufacture itself. This one reason it is important to eat good sources of protein. A couple of the essential amino acids are difficult to get from non-animal sources; this is why some vegetarians have a protein deficiency.

Polymorphism means that one letter in the genetic code is changed. Thus, one amino acid in the hundreds that make up the protein has been changed (similar to the analogy of substituting b for c and changing the word cat to bat). Amino acids have positive and negative charges. These charges cause the protein string to wad up into a ball. A change in one amino acid results in a slight change in the shape of the ball. The change in the shape of the protein results in a change in how strongly the protein binds to the cellular receptor, which affects how well the enzyme and the biochemical reaction works. In this way, polymorphism can result in a number of diseases (e.g., an increased risk of heart disease with an elevated homocystine level which is treated with folic acid).

There is, also, a significant degree of polymorphism in the Cytochrome P450 enzyme system of the liver, which is involved in Stage I of detoxification. This can result in a decrease in the ability of a person to detoxify and eliminate substances from his or her body. This decrease in the "buffering" capacity increases susceptibility to the chronic illness of MSD, as a result of being exposed to environmental conditions that most people easily tolerate.

Nutritional supplements provide the precursors or building blocks for the biochemical reaction. Taking nutritional supplements (in the right situation) can "push" the biochemical reaction harder to overcome the inefficiency caused by the polymorphism in the enzyme. This is much like turning up the pressure on a water hose, providing more force. The end result is to enhance the buffering capacity of a person's body, which is especially important in individuals who have a genetically reduced buffering capacity. This is one of the reasons why nutritional (supplements) therapy is beneficial for the treatment of some diseases.

Successful treatment of MSD requires a comprehensive, sustained approach to correct as many identifiable problems as possible. This means correcting one organ system, then another, until the patient's body starts to regain health. It is not an easy process, nor is it always successful. Hopefully, as we gain a better understanding of MSD along with better diagnostic tests and more effective treatment, patients will have a better prognosis. Validation and acceptance will also come with a better understanding of this disease process.

Epigenetics
Epigenetics refers to how our environment affects which genes are turned on and off. Epigenetics offers the explanation for why identical twins can get different diseases, and look different as they age (Nova Epigenetic Video #1). How our environment interacts with our genetic makeup plays a significant role in our health and disease. While we all have our own unique genetic make-up, not all of our genes are activated and working. Many genes, while present, are turned off and not functioning. Epigenetic variation can cause problems with metabolism, energy level, and even severe pain. The interaction with our environment (including food and different chemicals) plays a big role in determining which genes are turned on. This subject is the focus of the emerging medical discipline known as Epigenetic Medicine. (Nova Epigenetic Video #2)

Endometriosis and MSD
I believe that women with advanced endometriosis have MSD. This is a good example of a disease process where truly integrative approaches, including surgical, traditional medical and alternative therapies, are required for successful treatment.

The endometrial implants are a disease in the body that must be removed surgically. This anatomic disease is like a boat anchor that drags down the health of the individual. No matter what other treatments are instituted, the body will have to deal with the disease, since there is no non-surgical way to remove endometriosis from the body. A more detailed discussion of the surgical removal of endometriosis can be found in the description of the EVE Procedure™.

Conversely, the endometrial implants present in the pelvis may not represent all of the ill health of the patient. Patients with systemic (overall body) symptoms may well be suffering from MSD. This is one reason that even complete surgical removal of the endometrial implants may only treat part of the overall disease process of endometriosis patients. These patients in particular will most likely benefit from an overall approach to improve their underlying health to maximize the buffering capacity of their bodies, and thus the ability of their bodies to detoxify and regain optimal health.

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