Excerpt from Chapter 11:

A Patient's Frustration

I shared with her what happens often with a number of imaging studies, and took MRI studies as an example. Typical MRI results might not tell the whole story, although they provide doctors with high-resolution images of the body. Many times, for example, patients with strong lower back pain receive MRI results that show no pathology of note. Those MRIs are usually done with the patient lying down.

When weight-bearing MRI exams are done, with the patient standing, disk pathology that was not seen in the usual reclining MRI results often shows up. People suffering from low back pain while standing who have had MRIs performed while lying down and have been told that nothing abnormal was found may want to consider asking their treating physician about upright, or orthostatic, MRI testing. A radiological study involving more than 4,300 people over a 10-year period revealed a significant number of occult low back spine and disc pathologies that were not present in recumbent MRI findings.

MRI changes in the upright position that were not present when patients were lying down were found 68 percent of the time.7 Meniscal tears of the knee have also been discovered more often in weight-bearing MRIs than in recumbent ones.8


7. Splendiani A, et al. Magnetic resonance imaging (MRI) of the lumbar spine with dedicated G-scan machine in the upright position: a retrospective study and our experience in 10 years with 4305 patients. Radiol Med. July 28, 2015. (Epub ahead of print.) PubMed PMID: 26215713.

8. Ibid.



Excerpt from Chapter 2:

Health Care: Beware the Hidden Risks

All drugs basically go through four steps, or processes, called pharmacokinetics. Drugs are first absorbed, then distributed within your body, metabolized, and finally excreted.

However, not every one of the steps works the same for each person, or for the same person, at all times. Not everyone’s digestive system can absorb nutrients or medications as well as others. When drugs are distributed within your body and you have edema, you may need a bigger dose at times—or less if you are dehydrated. If you are very obese, some drugs don’t distribute well to fatty tissues.

Most drugs are metabolized in the liver. People whose liver is not working well may need a dosage that is different from others. Some people metabolize drugs in their liver very quickly, so patients are classified according to how quickly they metabolize drugs. This rate affects what a patient’s dosage should be, and drug toxicity can result if the dosage is incorrect for that patient.

The body handles excretion of drugs in different ways. Your kidneys do most of the work. Those who have kidney challenges may not be able to get rid of the residues of the drugs as well as others, which can also lead to drug toxicity.

Other factors come into play when considering how a person will react to a drug. Age is one of them. Older people typically have less muscle mass, and their kidneys usually do not work as well as when they were middle-aged or younger. They would usually need lower dosages or risk drug-toxicity issues. Diet and digestive issues can lead to malnutrition, which can affect the number of proteins in the blood available to bind with the medicine, influencing how the medicine is used by the body.

Polymorphism, a type of genetic variation common in the population, is studied in the expanding field of pharmacogenetics. It can also affect how you will respond to a drug, especially when variations for proteins named cytochrome isoenzymes are found. Approximately one-third of all medications are metabolized by the cytochrome P450 system.

Another factor in overprescribing is geographical. Researchers have found that doctors in some southern states prescribe twice as many antibiotics as doctors along the West Coast, per 1,000 patients of all ages. There are no disease-specific variations in these regions to account for the different rates.

The variation extends to other drugs as well and is part of a bigger pattern. Some states in the South prescribe almost three times as many opioid painkillers per 100 patients as states in the West.30 Sales of opioid pain relievers have increased threefold in less than 12 years, enough to medicate every adult in America with a typical dosage every four hours, continuously, for a month.31,32

What’s more, painkillers are prescribed twice as often per person in the United States as in Canada.33

If you go to Paris for your summer vacation or honeymoon and get sick, keep in mind that antibiotics are prescribed there over three times as often per 1,000 patients than if you spent those hot August days exploring the fjords of Norway.34

Recently, the top-selling drug in America, with over $7 billion in sales, was an antipsychotic drug, Abilify.

Women patients in America are at particular risk for receiving too many prescriptions. Over 25 percent of them have a prescription for a mental health drug.35The rate for men is around 15 percent.

Next time you stand at the checkout line in the supermarket or are in line at the movies, look around and count. One out of every four women in that line, statistically speaking, is on a prescription for a mental health drug.36Areas of the country where the incidence of diabetes is higher, such as the “diabetes belt” in certain southern states, have increased rates of mental health prescriptions due to higher levels of anxiety and depression among diabetics.


Surgical Interventions: Location Matters

The discrepancies in clinical approaches don’t stop with drugs. Surgery rates for the same procedure can be up to four times more frequent in one region of the United States than in another, not because there are more conditions or diseases in that area that need that type of surgery, but because of geographical differences in approaches. According to the authors of one national study, the decision to operate might depend strongly on where you live, not just on the doctor, or the illness or injury.37

For example, patients in surgical teaching hospitals in Salt Lake City are twice as likely to get knee-replacement surgery as patients in teaching hospitals in Manhattan. Back surgery in Nashville in surgical teaching hospitals occurs almost three times more often than in teaching hospitals in Philadelphia, and lower-extremity bypass surgery rates in teaching hospitals in Baltimore are over twice the U.S. average for teaching hospitals.On a global scale, spinal surgery rates in the United States are five times higher than in Britain and twice as high as in Canada and Europe.38


What You Can Do Now (found at the end of each chapter)

  • As your body changes, the drug that worked for you in the past may have a different effect on you now.
  • One good source of information on how your prescriptions may be affecting you, especially if you are taking more than one drug, is your pharmacist. He or she has received extensive education on the dynamics of drugs that most MDs haven’t. Many MDs don’t have the time during your visit to look at all the cross-reactions that can occur with multiple prescriptions. Many are under pressure to see a number of patients per day. Bring your list of meds to your pharmacist to review to make sure that they are not at cross-purposes with each other, or may be associated with other symptoms that you are having, and talk to your prescribing doctor if red flags come up.
  • The University of Maryland Medical Center has very good Internet resources to look up drug interactions and other information on prescription medicine. Go to http://www.umm.edu, and on the Health Information tab, choose the Drug Interactions Tool.
  • The Food and Drug Administration has a Medication Guides section for consumers. It contains information on more than 400 commonly used prescriptions, including what you need to know and what the drug does.103 Go to fda.gov for more information or to the “Notes” section for a more specific link.
  • If you are going to be using prescriptions, discuss with your physician what the signs and symptoms you are experiencing may be telling you about what else is not working well in your body.
  • Medical treatment is not always uniform for a particular condition. Choosingwisely.org is a good tool where you can find out whether experts in the field think that a particular test or treatment suggested to you is likely the best one. Consider talking to your doctor if you see discrepancies, or get the proverbial second opinion. Remember that when doctors refer you to health centers where they benefit financially, research shows that there is a strong tendency to recommend a lot more tests and surgeries as opposed to when they don’t have financial ties to the centers.
  • A lot of my patients tell me that the second-opinion doctor is not covered by their insurance plan, in particular with HMOs. My usual advice is to tell them to consider getting copies of their files, including lab and imaging results, and pay a board-certified doctor in that specialty for a consultation. You will pay for it out of pocket, but it’s usually for one visit and well worth it, if only for peace of mind that your treatment plan is the best one for you.


30. Opioid painkiller prescribing: Where you live makes a difference. Centers for Disease Control and Prevention: CDC VitalSigns. http://www.cdc.gov/vitalsigns/opioid-prescribing/index.html. Updated July 1, 2014.

31. Ibid.

32. Vital signs: Overdoses of prescription opioid pain relievers and other drugs among women—United States, 1999–2010. Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report (MMWR). 2013;62(26):537–42. http://www.cdc.gov/mmwr.

33. Opioid painkiller prescribing: Where you live makes a difference. Centers for Disease Control and Prevention: CDC VitalSigns. http://www.cdc.gov/vitalsigns/opioid-prescribing/index.html. Updated July 1, 2014.

34. Gooseens H, et al. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 365(9459):579–87.

35. Vital signs: Overdoses of prescription opioid pain relievers and other drugs among women—United States, 1999–2010. Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report (MMWR). 2013;62(26):537–42. http://www.cdc.gov/mmwr.

36. Vital signs: Overdoses of prescription opioid pain relievers and other drugs among women—United States, 1999–2010. Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report (MMWR). 2013;62(26):537–42. http://www.cdc.gov/mmwr.

37. Variation in Surgical Procedures. Dartmouth Institute for Health Policy and Clinical Practice: Dartmouth Atlas of Health Care. 2014. http://www.dartmouthatlas.org/pages/variation_surgery_2.

38. Ibid.

103. U.S. Food and Drug Administration. Medication Guides. http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm.



Excerpt from Chapter 3:

Can’t Stomach It?

…Your Stomach and Brain Atrophy

If you are 60 or over, there are important connections between the health of your stomach and the size of your brain that you need to become aware of. These important connections can have an effect on increasing the risks of developing mild cognitive impairment and Alzheimer’s disease.

Around the age of 60, our brain starts to atrophy, or shrink in size. If you know about these connections and take action, there may be simple steps you can take to slow down the rate of atrophy, as well as to give yourself a better opportunity of having a healthier brain, with good memory and concentration.

Good stomach function is one such connection.

As we age, the absorption of nutrients undergoes a decline. Additionally, as I mentioned earlier, as we age, we create less stomach acid. Proper levels of stomachacidity are needed, however, for our stomach to secrete what is known as intrinsic factor, which helps us to absorb vitamin B12 in the small intestine.

Low levels of intrinsic factor decrease our ability to absorb this important vitamin. Low levels of B12, along with low levels of folate and vitamin B6, hinder our body’s ability to lower the concentration of a substance known as homocysteine, which causes brain gray-matter loss.

Higher levels of these vitamins, however, decrease homocysteine and slow brain atrophy in elderly people with mild cognitive impairment who have high homocysteine levels.

That’s important, because accelerated brain atrophy is seen in people who progress from mild cognitive impairment to Alzheimer’s. High homocysteine levels lead to gray-matter destruction in the medial temporal lobe, the part of the brain associated with Alzheimer’s.14

Those at risk for Alzheimer’s with high homocysteine levels should consider blood testing to determine these vitamin levels. When needed, starting a vitamin B therapy can decrease gray-matter atrophy, or brain loss, in this important area by a factor of seven.15 Vitamin B12 levels in the blood can vary in a short amount of time. As a result, another test that indicates B12 levels, called a methylmalonic acid test, is usually run. However, this test is not routinely recommended for the elderly because it does not reflect B12 deficiency as well at an advanced age.

Metformin, the most commonly prescribed drug for diabetes, has been shown to markedly lower vitamin B12 levels after years of use.

Later, I will discuss the benefits of chewing foods properly that people aren’t usually aware of. One of them has to do with B12. Chewing helps the salivary glands to produce saliva, which binds to this important vitamin in a way that helps the B12 to survive passage through the acidic stomach, which would otherwise break it down, until it gets to the small intestine.


14. Smith AD, et al. Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial. PLoS One. September 8, 2010;5(9):e12244.

15. Douaud G, et al. Preventing Alzheimer's disease–related gray matter atrophy by B-vitamin treatment.Proc Natl AcadSci USA. June 4, 2013;110(23):9523–28.



Excerpt from Chapter 12

That Little Gland Does What?

The pituitary gland has a feedback system, like a thermostat, that tells the thyroid when to make more or less of certain hormones, mostly T4. It produces TSH to do so.

However, relying on TSH levels to determine the levels of thyroid hormones in the cells of your body may not be accurate. And that may lead to a wrong diagnosis or incorrect dosage. One of the reasons for this is that the pituitary’s feedback system does not always reflect the true levels of active thyroid hormones inside the rest of the cells of your body.6,7,8

It’s important to note that the thyroid hormone receptors in your pituitary are different from those in the rest of your body.9 Additionally, the transport system carrying thyroid hormone into your pituitary works differently than it does in the rest of your body. When the rest of your body is under different types of stresses, fewer thyroid hormones make their way into the cells, while the transport system for the pituitary often does not change much.

Therefore, the amount of TSH produced by your pituitary to balance thyroid production may not be a true reflection of what your body’s thyroid hormone levels really are. Think of it as being like a faulty thermostat that turns the heat in your home off and on. It works, more or less, but it may not be quite tuned in to your temperature needs.

Yet TSH levels, for many practitioners, remain the cornerstone in determining whether and how much hormone prescription medication to give. Often that is not enough.10

Some of the conditions that can drive fewer thyroid hormones into the cells of your body yet show normal blood pituitary thyroid hormone levels include diabetes, high cholesterol, toxins, chronic fatigue, anxiety, and chronic dieting.11


6. Holtorf K. Thyroid Hormone Transport into Cellular Tissue. Journal of Restorative Medicine.April 2014;3(4):53–68.

7. Van den Beld AW, et al. Thyroid hormone concentrations, disease, physical function, and mortality in elderly men.Journal of Clinical Endocrinology & Metabolism. December 2005;90(12):6403–9.

8. Fraser WD, et al. Are biochemical tests of thyroid function of any value in monitoring patients receiving thyroxine replacement? BMJ. 1986;293:808–10.

9.Bochukova E, et al. A mutation in the thyroid hormone receptor alpha gene.N Engl J Med. 2012;366:243–49.

10. Alevizaki M, et al. TSH may not be a good marker for adequate thyroid hormone replacement therapy. Wien KlinWochenschr. 2005;117(18):636–40.

11. Holtorf K. Thyroid Hormone Transport into Cellular Tissue. Journal of Restorative Medicine.April 2014;3(4):53–68.1.



Excerpt from Chapter 15:

Seeds of Health

….Everything in our body, as in nature or a garden, is connected to each other in some way and creates effects.

Your stomach also acts as a sentry, a gatekeeper, as well as one of the organs for digestion. It helps to kill bugs, such as viruses and bacteria, before they enter other parts of your body.I have already detailed how stomach dysfunction can affect your digestion and your intestines. A healthy stomach helps prepare the liver and pancreas for digestion.

Let’s quickly review some of the latest topics that we’ve touched on:

  • Improperly digested food and bugs can cause a strain on your small and large intestines, which can lead to intestinal inflammation.
  • Improperly digested food can also lead to permeability of your intestinal walls, so that larger proteins and bugs get into your bloodstream and affect other parts of your body. That includes your brain, leading to brain inflammation.
  • Brain inflammation, in turn, can cause parts of your brain to not work as well, which means these parts have more difficulty regulating other parts of your brain, including the health of your intestines. Brain inflammation can also lead to difficulty concentrating, moods, and memory issues.

A vicious cycle of degenerating health begins, with symptoms that might take years to appear and seem intractable. These symptoms may appear in other parts of your body down the road. The treatment for them is usually to treat the consequences, not the root causes.

A brain that isn’t functioning properly can help raise blood pressure as well as cause a number of digestive issues. Brain inflammation can lead to gut and joint pain as well. People might think it’s just arthritis, yet arthritic lab work and x-rays are often negative. The inflammation might be arising from brain dysfunction.1,2,3,4,5Joint pain can be caused by brain issues. An integrated approach would also involve assisting brain function when needed.


1. Kwan CL, et al. Abnormal forebrain activity in functional bowel disorder patients with chronic pain. Neurology, October 25, 2005;65(8):1268–77.

2. Meerman EE, Verkuil B, Brosschot JF. Decreasing pain tolerance outside of awareness.J Psychosom Res. March 2001;70(3):250–57.

3. McDougall JJ. Arthritis and pain.Neurogenic origin of joint pain.Arthritis Res Ther.2006;8(6):220.

4. Walton KD, Dubois M, Linas RR. Abnormal thalamocortical activity in patients with complex regional pain syndrome (CRPS) type I. Pain.July 2010;150(1):41–51.

5. Schulze J, Troeger C. Increased sympathetic activity assessed by special analysis of heart rate variability in patients with CRPS I. HandchirMikrochirPlastChir. February 2010;42(1):44–48.



Excerpt from Chapter 24:

Fat Children? Act Now!

What You Can Do Now (found at the end of each chapter)

  • Help your children to be slimmer and healthier when they become adults by not giving in to demands for junk food.
  • Exercise is a habit best instilled when very young.
  • Make sure that someone with a good clinical eye tells you whether or not your child is overweight; research shows that your loving eyes can lie!
  • If you want to have a child and you are overweight, whether you are a man or a woman, the time to lose the weight is now, before conception.
  • A gram of omega-3s a day has been shown to help reduce aggressive behavior in children.
  • More computer time has been shown to decrease reading and writing skills in children. Reducing computer time also reduces obesity.
  • If you have an obese child, consider a blood test for inflammatory markers discussed in this chapter. These tests are inexpensive. Increased levels of the markers during childhood lead to much greater chances of depression, diabetes, and psychosis in adulthood.
  • Grapefruit juice and green apples are great for helping with weight loss and with reducing high fat and sugar levels in the blood; one study showed one glass of grapefruit juice a day to be as effective as the diabetic drug metformin.



Excerpt from Chapter 31:

The Essential You: Deeper Meanings to Illness

Health and Wholeness

Those who believe that all of life’s experiences have something to teach us are aligned with the viewpoint of many ancient cultures that believed that the central part of us, who we really are, came into this life with a purpose, with goals.

In other words, they believed that we are here for a reason.

They believed that good health is a reflection of this central aspect of ourselves, the essence of who we are beyond biology, or that which Swiss psychologist Carl Jung called the “Self.” When a person is not aligned with her highest purpose, illness and disease arise as a signal and as a consequence. It serves as an indicator that she has lost her highest perspective.

Instead of only treating symptoms or conditions, they would explore ill health as an indicator of deeper life meanings.

Let’s travel a few thousand miles and a couple of thousand years back in time to observe an example of this. The Romans used to have healing temples throughout their empire. A requisite to enter one of these temples and to receive healing was for the person to come to terms with his illness, to reconcile himself, since it was believed that without doing so, there could be no true healing.1

Just what does “coming to terms” mean? Is that reconciliation? Carl Jung spoke of health and healing as a process of the unconscious becoming conscious. He called that process “individuation,” which involves the integration of the conscious mind, or ego, and the unconscious, or central aspect of the person: the Self.

He believed that the nature of this internal, central Self was a yearning for wholeness, equivalent to the yearning for God. He spoke of illness and disease as being the crucible where this transformation took place, and that only in this Self could healing take place and the person be made whole.2

These concepts about health and wholeness have a bearing on our symptoms and our biological functions, our health. But they can also go much deeper and have a bigger impact on our lives. It’s a deeper viewpoint of health that is important for our healing, in the most profound sense of the word.

For many, it forms a key point to attaining health. It does not discount clinical treatment for these symptoms and illnesses; they should not be ignored. We’ve made wonderful technological advances in the science of healing and should take advantage of them whenever possible.

One of the topics we’ve been exploring is that symptoms and diseases can be the consequences, or expressions, of deeper dysfunctional patterns of cells and tissues in our body.

Instances might arise that allow us to discover that the root causes of our illnesses go beyond physical dysfunction. An illness might be a symptom, a consequence, of a loss of balance by the ancient definition of health at deeper levels: a loss of wholeness.

It could be related to a loss, or dysfunction, between a person and the balance and harmony of nature and its laws. On that same note, it’s interesting to see how the wholeness-based approach to health has been treated in many spiritual works across continents and millennia.

Let’s look at some examples.

  • In the ancient Indian ayurvedic healing system, the relationship between the patient and nature is central. The practitioner’s intent is to help the patient balance her physical, emotional, and spiritual aspects. In this system, yoga is used as a tool to bring balance to these three aspects.
  • In the New Testament, more than once, when Jesus is telling someone that he or she has been healed, he uses the phrase “made whole.”
  • In traditional Chinese medicine, all aspects of a person’s health are used for diagnosis—not just the physical and nutritional, but also the emotional, mental, and spiritual aspects. The intent is to return to a balance of the energies flowing through the patient.

These examples might remind you of similarities with the philosophy of chiropractic that I detailed earlier.All of these approaches, from different eras, countries, and even religions, share a viewpoint on who we essentially are: spiritual beings in deep resonance with the rhythms of life.


1. Sanford JA. Healing and Wholeness. Mahwah, NJ: Paulist Press; 1997.

2. Jung C. Memories, Dreams, Reflections. New York, NY: Pantheon Press; 1961.