But in an energy-constrained future? Clearly, it will be too late to get started building a healthy body (and mind!) once things get complicated.

At the present moment, on the other hand, we have plenty of knowledge we are not acting on. When I began to contemplate health care and powerdown, I got rather depressed. How will we deal with the multiple minor issues we now resolve with antibiotics? How about all my patients on thyroid replacement therapy? What about all the depressed people doing at least a little better on serotonin reuptake inhibitors?

But then I read Dr. Mark Hyman's books ("Ultraprevention", "Ultrametabolism", and "The Ultramind Solution"). I'm not crazy about the ultra-gimmicky titles, but honestly, the science inside the books seems quite solid. Every time I turn to the Journal of the American Medical Association, or to PubMed to verify a claim, I find several references, most of them quite recent, from what appear to be solid research.

Also, Dr. Hyman explains certain things I just had overlooked. First, he reminds me what we used to say with my friends whenever we got tired of hospital medicine: pneumonia is not an antibiotic deficiency, so why do we not have something we can do for it other than antibiotics? Is it enough to say a depressed person lacks serotonin and boost the levels with pills, or do we need to figure out why the serotonin level is so low? I know, in the prevailing psychological view, it is a result of life experiences coupled with genetic predisposition, but what if this explanation was incomplete?

Second, Dr. Hyman points out that we are what we eat, but not just in a superficial way. Each cell in our bodies is made up of the foods we eat. One key component is essential fatty acids. These are called "essential" because our body cannot manufacture them. They have to be eaten. So it matters if you are having enough omega-3 in your diet, not just for some future possible chance of getting heart disease, but next week, next month, your diet will determine whether your cells can communicate properly with each other.

Also, somehow, in medical school, we got the idea that vitamin deficiency diseases were a thing of the past. Once in a while, some very eccentric patient would get admitted with scurvy, or beri-beri, but this seemed of no consequence. Of course, a diet of burgers and fries makes lots of people unhealthy, starting with Morgan Spurlock ("Supersize Me"), but what about a diet of cereal, milk, bagels, pizza, macaroni and cheese?

Here's what your food, really, should do for you:

1.     It provides enough energy, but not too much.
Eating too much food, in and of itself, leads to disease. This is because digestion and processing of food causes “inflammation”. This word, which means “heating up”, indicates that certain biochemical reactions happen in your body when you eat. Some foods are worse than others, but all foods do it. 

 2.     It does not cause unnecessary inflammation. Inflammatory foods include meat, dairy, sugar, white flour and other white processed foods. Inflammation causes release of a type of “communicator molecule” called a cytokine. Medicine is evolving in the direction of blaming inflammation for more and more diseases. The classic inflammatory illnesses were asthma and autoimmune diseases like rheumatoid arthritis. Then heart disease got added to the mix. Now it turns out depression and ADHD may belong there too. A lot of thyroid problems fit with this as well.

 3.     It actively fights oxidation. Oxidation is like “rust”, inside your body. It is a name for a biochemical type of reaction. It is a normal thing that happens when your tissues are exposed to oxygen or other oxidating molecules. This is what the anti-oxidants are all about. They are found in plants. Less processed, more colorful plants have more anti-oxidants.

 4.     It provides detoxification. Toxins are everywhere: our hormones, manmade chemicals, plant components. We need to eat detoxifiers. These are the magical foods: broccoli sprouts, watercress, garlic, onions, spices, green tea. Fiber is also a detoxifier. These have been proven to prevent human cancers – this is not hypothetical or based only on rat experiments.

 5.     It provides the appropriate building blocks for the cells in our body. You have to eat the right balance of omega-3 and omega-6 fatty acids, or your cell membranes will be built wrong. 

 6.     It provides enough vitamins and nutrients. It turns out that is very hard to do unless you are paying close attention. In part that is because the plants we eat have been changed by agriculture over the years, bred for yield and shelf life, and not for nutritional content. In part that may be because we face more toxins than our ancestors. In part, it could be that it was always, and continues to be, hard to be a healthy human.

 7.     It provides beneficial bacteria. It turns out that we live in a body full of billions of bacteria, and that they are busy doing stuff in our intestine. The good ones can help us absorb nutrients, for example; the bad ones actually manufacture substances that make us feel bad. Unfortunately, we don’t generally take in enough fermented and unpasteurized foods to properly colonize our intestine.

 8.     It doesn’t cause a “leaky gut”. I thought this was alternative medicine but it’s not. Diseases such as asthma, and who knows what else in the near future, are related to this concept of a leaky gut. Due to toxins and poor dietary choices, many people’s intestine lets through too much undigested stuff, which then gets into their bloodstream with adverse results. The trouble with this concept is that there is little reliable evidence what to do about it. A six-week elimination diet is that only reasonable thing that I see proposed. One would eliminate gluten and dairy, which are the usual culprits, then reintroduce them and observe.

 9.     It regulates hormones by providing a steady source of energy. A plant-based, sugar-free diet regulates insulin for example.

 10.  It actually “talks” to your DNA, turning on genes that will help your health, and turning off genes that favor inflammation and cancer. After a few weeks on such a diet, hundreds of genes are turned on or off. You could say that you will be genetically altered. Essentially, you have a chance at a whole new body. Even the skeleton is completely rebuilt every 10 years. Even the brain gets new cells (the argument that no new neurons are made after birth was wrong).

The new food pyramid has “exercise, relaxation and stress control” at the bottom. They set you up to resist the temptation for too much beer, baked goods and sugary treats. The next level is fruits and vegetables. Up from that you have whole grains (NOT flour). Then you have nuts, seeds and legumes, and the rest is to be eaten sparingly. Many sources add small cold-water fish, such as sardines, but with fish, you have to watch the mercury, and make sure it’s wild-caught.

So what will you serve the family for the holidays? A heaping plate of anti-oxidants? Detoxifiers? Can we sneak some in along with the sugar and butter?

What to do, though? Is it all denial and deprivation? Where to start?

Enter the new medical science of "functional medicine". It's not brand new. It's not "alternative". So where has it been, while I struggled with little success, to improve the health of patients in clinics? Anyways, better late than never.

1. The intestines are the starting point. Toxins, stress and poor dietary choices have rendered the lining "leaky", leading to a host of problems. So the starting point is to fix that. Typically, functional medicine providers recommend a 6-week trial of a non-dairy, non-gluten diet, coupled with lots of fiber (preferably from ground flaxseed), and probiotics.

2. The leaky intestines have been absorbing vitamins and minerals poorly. A multivitamin is recommended for that.

3. Poor dietary choices often result in too many "bad fats". As the cell membranes are made of fat, you need to have a lot of good ones, so you can build membranes that function well. Omega-3 fatty acids, and the fats found in nuts, seeds, and avocadoes are recommended here. Limit animal sources of fat.

4. Exercise and relaxation have far-reaching effects. They are also crucial parts of the rebuilding program.

5. Even if you eat organic and ban toxic cleaning products from your house, you will be exposed to toxins. You can at least focus on detoxifying foods, of which there are many: green tea, many spices, cruciferous vegetables, etc...

6. Your body has been aging too fast given the above lifestyle. The recommendation for this is colorful vegetables and fruit.

7. There's more that's tailored to each individuals - neurotransmitter levels might be low, and one would benefit from amino acid supplements. The energy centers of the cell, mitochondria, might need some help. Hormones such as thyroid and insulin, and estrogen/testosterone, might also need balancing.

But you get the picture. It's not rocket science. How do we know it's worth a try? I think this is for each of us to judge. For me, functional medicine finally puts together the confusing picture that hundreds of individual scientific studies has been trying to convey - you can't do just one or two actions and make a difference. Each body system, each enzyme, each neurotransmitter depends on many others functioning properly. There are many ways to paralyze each enzyme. You really need to be comprehensive to make a difference. We have shown the effect of each poor choice. Some of them (smoking for example) override all others. But most are just one piece of the puzzle, and without the other pieces, the picture does not emerge.

Well, I'll be... how in 20 years of family practice, the topic of excess winter deaths from cardiovascular diseases had never come up.  Not in the pages of the Journal of the American Medical Association, I don't think.  Even now googling excess winter deaths I come up with British articles.

Anyway, it may indeed be true that people die more in the winter, not only from pneumonia (which you would expect, as the germs are around more in the winter, and influenza can lead to pneumonia and death, for example), but also (in fact more so) from cardiovascular causes.

Turns out that excess winter mortality is not a huge problem in the US.  Maybe because much of the country does not have cold winters, and because the houses are not as drafty as in the UK, and because there is not tradition of suffering in the cold as there might be in Britain.  Anyway, I am hard at work trying to think up cheap low-tech strategies to minimize winter deaths in Britain.

I graduated from medical school in Montreal, Canada in 1987, and did a three-year residency in family medicine at Brown University from 1987 to 1990.  I worked in community health centers for 20 years, first in Lawrence, Massachussets, then in the San Francisco Bay Area (mostly in a clinic serving mainly homeless people in San Francisco, Tom Waddell Health Center), and in San Mateo County.  In the last few years, I have worked for community health centers in the Greater Denver metro area, and in my present hometown, Boulder.

Somewhere in there, I took two years off for a masters in public health, with focus in maternal and child care.  My interest was in parenting and specifically prevention of child abuse.  During the second year, I focused on a preventive medicine residency, studied unexpected child deaths in San Francisco, learned much about how income disparities and public health campaigns impact child deaths, and went back to work serving homeless families and other homeless folks in San Francisco.

I admit I do not know much about "alternative" medicine, other than the simple fact that we all care about people and believe that the human mind can do much to influence, heal or hurt the human body, and that the practitioner had better know how to use that to the patient's advantage.

I am curious as to how Peak Oil will affect the practice of medicine. It is under siege as we speak.  First it costs too much, second many people have lost faith in the rushed opinions and lack of bedside skills of some doctors. What happens when there is no money in the system for anything remotely like what we have today?

I am not that interested in figuring out the ways in which the medical system we have relies on far-flung suppliers. I think though that as we begin to feel a greater sense of empowerment around growing our own food, making our own clothes and other essentials, even generating some of our own energy, then we will want to understand as much about the human body (in health and illness) as we can. In an energy-constrained world, we can only hope there will still be some place for "specialists", because otherwise we will surely regress tremendously, but that doesn't mean we can't all be a lot more savvy than we are now.

So read on, as I find a way to teach some of what I have learned.