The Creator’s Design
Developed and compiled by
Joseph B. Gentzel, B.S., P.T., T.N.
Inflammation is one of the key markers and symptoms to a multitude of medical problems. Recent advances in research and study of this area is revealing that a significant amount of the problem is diet and lifestyle related. The list is quite long but includes:
· Type 2 diabetes- including metabolic syndrome
· Overweight and obesity
· Macular Degeneration, cataracts and other eye diseases where inflammation is an associated symptom.
· Auto-immune Disorders
· Fibromyalgia and other ill defined musculoskeletal problems that is chronic in nature. This would involve overuse and repetitive motion problems like carpal tunnel, etc.
· Heart disease
· Alzheimer’s disease
· Sleep apnea
· Inflammatory bowel diseases such as Celiac disease, Crones Disease, IBS
· Psychiatric and even emotional problems such as simple anxiety and depression.
· ADHD & ADD disorders in children and adults.
· Prostrate inflammation and hyperplasia that can progress to cancer.
· Genito-urinary inflammatory problems in both men and women
· Female reproductive inflammatory problems including endometrial, peritoneal, cervical and breast.
· Inflammatory gum disease problems.
· Many others where inflammation is a symptom.
Most of these diseases and conditions are associated or caused by chronic inflammatory states in the body. Many times these are caused by or contributed too by our contemporary western diet and lifestyle. Our contemporary food supply with its very high (20 to 1) Omega 6 to Omega 3 ratios, contributes significantly to the problems. The abundance of inflammatory markers such as (C Reactive Protein [CRP], Tumor Necrosis Factor-alpha [TNF-alpha], interleukin 6 [IL-6], etc.) and other hallmarks of this condition such as HDL/TG ratio and Omega 6 to Omega 3 essential fatty acid ratio indicate diet as a prime culprit in these states of disease and poor health. Diet and lifestyle modification have shown decreases in the inflammatory markers and ratios that correlate positively with improvement in symptoms and health. These inflammatory markers and dietary ratios are important as they provide objective information about the effects and effectiveness of diet modification on these inflammatory conditions that are linked to serious disease and disability.
Dietary problems actually begin in Utero with the mother’s diet. Whether we are breast fed or bottle fed makes a difference.  Many problems later in life are attributable to these very early stages, so it should not come as any surprise that the rate of childhood obesity and inflammatory based problems, including food allergies, are on a dramatic rise. Each generation will get worse in date of onset and degree of pathology under this model. These problems continue throughout life. The approach of good gestational diet plus breastfeeding the offspring is the most basic and effective preventative in our arsenal of approaches to problems later in life. That is assuming the TN type diet essentially continues during the lifetime or is reinstituted at some point in time when pathology is not past the point of the body’s remarkable recuperative processes to heal itself and return to its normal state of function.
Dietary problems in the body are cumulative. Over time this has resulted in epidemic numbers and increases in almost every category. For example: sixty-seven (67%) percent of us are overweight and obese. The numbers are greater in the poor and minorities, with non Hispanic minority women being right at 80%.
The numbers in the other conditions and diseases that have inflammation as a cause or associated symptom are similar, although not quite at these very high levels. The data shows all conditions have shown steadily increases over past 20 years. There is a debatable opinion just recently in 2009, by CDC officials that overweight and obesity numbers have not increased over the past 10 years. This hotly debated opinion, to its credit, notes quickly, that the very high numbers are no better over these ten years and continue to be very serious.
Most present medical (and other) intervention deals with symptom control. The most obvious problem(s), other than dealing with the cause, tries, with complete failure, to address a myriad of symptoms that are all over the board in scope and relevance. This is the true wild west of misinformation. This is the most classic example of “information cascades” I have ever encountered. It is a sad state of affairs when bariatric surgery is actually viewed as a preferable option to address the morbid obesity and higher levels as opposed to the 100% failure rate in weight reduction documented in every group studied with conventional diet and exercise regimes. The data clearly documents by 10 years that all bariatric surgery procedures fail as well in all groups studied. With the mortality and morbidity associated with the procedures themselves it seems incredible that this big business is flourishing and expanding now to include our children in this radical surgery.
Therapeutic Nutrition, on the other hand, addresses the diet and lifestyle problems with education and therapeutic intervention aimed at removing the cause or irritant factors in diet and lifestyle plus return to normal body status. Progress is documented by lab results for inflammatory markers, and other lab values. In addition objective body measurements plus the professional evaluations and assessments of Physical Therapists and other health care practitioners provide excellent documentation of the status of patients.
At the core of the program is the most basic understanding of how our bodies react to the food and lifestyle we lead. In other words; understanding how we were made and the resultant physiology of our bodies to these daily occurrences in the form of diet, and other factors that influence the body in both positive and negative ways. While this is not a lesson in faith and religion, nonetheless, the understanding of how we were created is part and parcel of successful management of our health. The Creator’s Design is basic to the program and really puts it into its most meaningful place. For this reason I suspect there will be some major built in resistance to very obvious aspects of this approach for many health problems facing mankind worldwide. Those who do not want to believe in the role of God, just look at the pure science. Since God also made the science, it will work for even the most skeptical and biased mind.
Education of staff and health care professionals are central to success of this program. This is especially true since education and follow up with patients/clients is so germane to the eventual success of individuals and groups of patients.
Therapeutic intervention involves assessment, education and teaching, combined as indicated with more traditional approaches of Physical Therapy. Long term follow-up is an essential part of the program as the diet and lifestyle applications are a big change for most people and at variance with so many normal modes and long held beliefs of these applications.
The confusion and misinformation from our “experts” is most discouraging. This adds to the misery and failure every group is experiencing in this area. This is most evident by the sheer numbers with overweight and obesity. Success has to be gauged long term, not just a few months or even years. At ten (10) years all the current approaches fail in all groups. We do seem to find an occasional individual who succeeds, but this success does not translate to any public health improvement nor is it reproducible in any groups.
Dietitians and nutritionists seldom have the therapeutic skills to treat a multitude of inflammatory disorders and third party reimbursement is a problem in many settings. This approach lends itself to faith based groups, non-profit entities, commercial entities or some combination thereof.
While diet is the keystone to this program, there are many non dietary measures that complement and enhance the dietary aspects. Some of these are:
· Supplementation; many times with high Omega 3 fatty acids with high EPA component that will assist with decreased inflammation. Over the long run this will help with the next item. 
· Vitamin D and Vitamin K. These two vitamins are being described as the “forgotten vitamins”. Vitamin D is emerging as a very important vitamin. Establishing proper levels of this vitamin in our contemporary world most likely will necessitate supplementation. , Michael R. Eades, M.D., in his excellent blog, recommends supplementation and explains why. 
· If the diet is inadequate due to appetite or other factors, take complete vitamin supplement as needed.
· Look for food and environmental allergies. Try to eliminate them.
· Proper Sleep. 
· Relaxation 
· Proper breathing (one of the most important and one of the simplest to address) 
· Diminished stress 
· Diminished anger 
· No alcohol ingestion, drugs (medication prescribed and carefully monitored by physician excepted) or tobacco products.
· Promote love of self and self worth. Help someone else.
· Other people and/or animals in your life 
· Mild (very low impact) kinetic exercise to stimulate the mechanoreceptors and produce indigenous opiates in the body in a frequent (preferably daily) schedule.
· Weight reduction, if that is a problem. Since this is a cycle problem i.e. the dietary inflammation causes fat cell engorgement which in turn produces inflammatory prostaglandins back into the body. The cycle must be broken and maintained.
· Belief in a higher being,  and Intercessory Prayer where appropriate.
· Promote activities that increase and produce indigenous opiates such as visualization, imagery, meditation, Yoga, and related, etc.
· Use of acupuncture, acupressure and potentially TENS to improve indigenous opiate production in the body, promote relaxation and modulate pain in a natural way that diminishes or eliminates drugs for same. The kinetic exercise will aid this area greatly and can be as simple as using a rocking chair for 30 minutes daily and/or other times (very powerful).
· Appropriate, careful use of timing of food ingestion. Fasting, including intermittent fasting, produces an anti inflammatory response in the body. This response can have some residual effects as long as 20 days. ,  This is not recommended or is to be employed very carefully with people who have eating disorders such as binge-purge.
Additionally a diet that is an excellent quality Therapeutic Nutrition diet, with its anti inflammatory properties, will enhance the therapeutic effects of all the above adjunct therapeutic modalities. The body will respond in a manner that improves its natural healing affect and return to its normal state of health.
The references footnoted here are just a small sample of the overwhelming, objective scientific information that supports the various components employed in Therapeutic Nutrition. Physical Therapists are uniquely qualified to understand and, once proficient in the dietary aspects of the pathology, to make a dramatic contribution to so many of the health problems facing our society today.
Unfortunately much of this mountain of information seems to have gone unrelated to each other component. It’s like the idiomatic phrase:
Can’t see the forest for the trees!
Which, of course, means; not seeing the whole picture because of looking so intently at one specific portion of the whole scenario. No where does this principal occur more than in nutrition and certainly as it relates to the various components of that science. The data and research available is voluminous, but somehow it seems to be kept fragmented and separated. That time has come to an end. Therapeutic Nutrition is an attempt to provide Physical Therapists and other health care practitioners with one of their most powerful modalities for preventing and treating a multitude of diseases facing the world.
The diet paradigm goes both ways i.e. if a diet that is inflammatory contributes and causes a host of problems in the body, then a diet that is anti inflammatory will combat and help the body deal with an inflammatory state. It does not matter to the body if the original origin that caused the inflammatory state was diet or some other source. Of course, if the original cause was the inflammatory diet; a anti inflammatory diet will offer assistance in two therapeutic objectives;
1. Remove the inflammatory cause
2. Provide anti inflammatory agents to the body to combat the established inflammation.
The research going on with HIV/AIDS, especially the “brain aging” seen with this condition is fascinating. It offers hope that any measure used to diminish the inflammation will help both the brain aging and the disease itself. Diet and supplementation as a therapeutic modality in this area could become important.
Under present reimbursement guidelines Physical Therapy (PT) is reimbursable. The allowable PT ICD codes for the various interventions required are available to the extent this coverage can be included under federal and private insurance. The most common treatment avenue now is alternate therapeutic interventions that are globally not reimbursable. This makes available a potential added revenue center to a medical practice, health care institution or free standing private office. Senior living communities lend themselves to having areas that have a premium level of service embracing the parameters of the Therapeutic Nutrition lifestyle including the therapeutic component combined with the diet education and/or preparation as appropriate. Church and charity groups can implement education, teaching and assistance in obtaining the basics for this program to work in their clients lives. Cost and/or reimbursement are key to success in using this approach successfully. A massive faith based involvement could hold great benefit for the poor and minority populations around the world. After all, it’s the Creator’s Design way to good health and longevity.
 Don Sharkey, Michael E. Symonds and Helen Budge, Adipose Tissue Inflammation: Developmental Ontogeny and Consequences of Gestational Nutrient Restriction in Offspring, Endocrinology Vol. 150, No. 8 3913-3920, 2009, ONLINE Abstract: http://endo.endojournals.org/cgi/content/abstract/150/8/3913.
 Dörner G, Grychtolik H., Long-lasting ill-effects of neonatal qualitative and/or quantitative dysnutrition in the human, Endokrinologie. 1978 Feb;71(1):81-8., ONLINE Abstract http://www.ncbi.nlm.nih.gov/pubmed/639768.
 CDC, ONLINE: http://www.cdc.gov/nchs/fastats/overwt.htm
 Latina Women: Fight Against Obesity, ONLINE: http://www.umich.edu/~ac213/student_projects05/la/obesity.html.
 NCBI, March, 2005, EPA and DHA reduce LPS-induced inflammation responses in HK-2 cells: evidence for a PPAR-gamma-dependent mechanism., ONLINE: http://www.ncbi.nlm.nih.gov/pubmed/15698426
 Medical News Today, Relationship Between Vitamin D Deficiency And Increased Inflammation In Healthy Women, April 9, 2009, ONLINE: http://www.medicalnewstoday.com/articles/145727.php
 Wellsphere, Vitamin D and Inflammation, April 25, 2009, ONLINE: http://www.wellsphere.com/heart-health-article/vitamin-d-and-inflammation/656658
 CBN News, What’s the Real Story on Vitamin D?, November 17, 2007,ONLINE: http://www.cbn.com/CBNnews/269033.aspx
 Dinges DF, Simpson N.; NCBI, Sleep and Inflammation, ONLINE: http://www.ncbi.nlm.nih.gov/pubmed/18240557
 Reuters India; November 6, 2007, Yoga Found to boost health in Heart Failure Patients, ONLINE: http://in.reuters.com/article/health/idINN0530481120071105
 Richard P. Brown, Patricia L. Gerbarg. The Journal of Alternative and Complementary Medicine. February 2005, 11(1): 189-201. doi:10.1089/acm.2005.11.189.
 The American Journal of Psychiatry, September, 2006, Thaddeus W.W. Pace, Ph.D., Tanja C. Mletzko, M.S., Oyetunde Alagbe, M.D., Dominique L. Musselman, M.D., M.S., Charles B. Nemeroff, M.D., Ph.D., Andrew H. Miller, M.D., and Christine M. Heim, Ph.D.; Increased Stress-Induced Inflammatory Responses in Male Patients With Major Depression and Increased Early Life Stress, ONLINE Abstract: http://ajp.psychiatryonline.org/cgi/content/abstract/163/9/1630
. Relationship between anger & inflammation, ONLINE: http://www.cidpusa.org/anger.html.
 Genome Biology, September, 2007, The molecular signature of loneliness, ONLINE: http://genomebiology.com/pressreleases/pressrelease11September07.asp
 King DE, Mainous AG 3rd, Steyer TE, Pearson W., The relationship between attendance at religious services and cardiovascular inflammatory markers, Int J Psychiatry Med. 2001;31(4):415-25, ONLINE Abstract: http://www.cidpusa.org/prayer.html..
 Eades MD, Michael R.: ONLINE: http://www.proteinpower.com/drmike/intermittent-fasting/inflammation-and-intermittent-fasting/ ; Blog of Michael R. Eades, MD; Inflammation and intermittent fasting, August 13, 2007.
 Annals of Nutrition and Metabolism, ONLINE: http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=100954&Ausgabe=232822&ProduktNr=223977, Interleukin-6, C-Reactive Protein and Biochemical Parameters during Prolonged Intermittent Fasting,; Fehime B. Aksungar, Aynur E. Topkaya, Mahmut Akyildiz; Abstract from Volume 51,Number 1, 2007.