The first stage of my GEMINI diagnostic matrix is the identification of inherited and genetic risk. This will show any weak spots that provide opportunities for infection, inflammation and injury.
The family history is the critical key to understanding inheritance, but an increasing number of genetic tests are proving useful for identifying methylation defects, predisposition to infection, gluten reactivity and autoimmunity and even adverse drug reactions and dosage requirements.
Irrespective of the genetics, epigenetic expression under the influence of diet, stress, and even the microbiome of the gut is the hot new area of research. A body of evidence for transgenerational inheritance of acquired epigenetic changes is growing.
As if that weren't enough, we are now seeing the re-emergence of human endogenous retroviruses (HERV), ancient viruses copied into our DNA and thought to be fossils of past infections. Research in the areas of autoimmunity and even chronic fatigue syndrome seem to be showing that these long "dead" DNA viral segments are resurrecting and inducing abnormal immune responses as we fight our old enemies.
Knowing enough about genetics and epigenetic expression to keep away from some common trapdoors and reduce some of the risks is the first step of GEMINI.
After I graduated, my next training was in Environmental Medicine with the Australian Society of Environmental Medicine (ASEM) from 1985. I was working in a rural area on the Central Coast, and was repeatedly seeing farmers who should have been in excellent health suffering from persistent inflammatory and neurological conditions for which there was no clear explanation.
What tied these cases together was the use of a class of pesticides known as organochlorine insecticides, such as dieldrin, heptachlor, chlordane and DDT. Some colleagues and I got together in the late 80s to visit America and see Dr Rea's Dallas clinic and John Lasseter's laboratory, AccuChem. We were so impressed that on returning to Australia we established what we believe was Australia's first inpatient controlled-environment hospital unit in Sydney, the Special Environment Allergy Clinic (SEAC).
This Clinic opened its doors in 1989 and closed in 1994. During this time we saw and treated over 300 inpatients with a combination of chronic fatigue syndrome and chemical sensitivity or chemical toxicity. We carried out clinical research which was published in the Medical Journal of Australia in 1995, identifying significantly higher levels of organochlorine pesticides in CFS subjects compared to controls.
The high proportion of agricultural workers, especially farmers, admitted to our clinic (before it was closed down under political pressure in 1994) seemed to confirm our suspicion that exposure to such pesticides was harmful despite the toxicological literature suggesting otherwise. Of course, we now know the impact of those pesticides on the bacteria in our gut and in epigenetic expression, and there is now general consensus that the type of harm that we described in 1995 as a result of pesticide exposure is most likely true and causative in nature.
What is absolutely clear is that humans depend for health upon a rich diverse external environment devoid of poisons and rich in nature. We depend on that environment for our breath, for the water we drink and for the food we eat. The contamination of our planet and the destruction of biodiversity weakens and impairs us. It makes us susceptible to illnesses that we have not previously encountered.
Protecting and cleaning up the environment that we have contaminated starts in the home, the school and the workplace, and spreads out from there to our back yards, our community, our parks, our beaches, and ultimately to the planet.
Healthy, vibrant and natural surrounds, nature's noise and perfumes, the wind brushing our skin and sunlight waking us in the mornings to the marvellous beauty of our planet – this is the environment we were born for, the environment that sustains us and our health, and the cycle of life that shepherds us through our days and nights, and from birth to our eventual death.
Rebuilding our relationship with nature can be really difficult, but small steps go a long way, and allow us to rediscover the healing magic can come from this sacred communion.
Despite what Wikipedia says, the microbiome is neither new nor recently discovered. It has, however, become the hot topic in medicine as the scientific community rediscovers the intimate relationship between ourselves and our "little masters" the gastrointestinal flora known as the microbiome.
Why the fuss? Yes, these bacteria outnumber us 10 to 1 if you just count the cells, and 150 to 1 if you count the genes. But there's less than a kilo of them and they're, well, kind of dirty. They make poo! How important can they be?
The answer seems to be, "more important than we ever could have imagined". We depend upon them for nutrients that we cannot make or absorb from our diet. They control energy harvesting and obesity, especially when provided with loads of sugar. They are very involved in inflammation, and our immune system is hugely influenced by their numbers and diversity. They manipulate our autonomic nervous system and affect mental functioning very profound ways. When the balance is distorted by antibiotics in drugs or foods the proportions change and they can turn feral very quickly. They were around before we were born, and if we are buried rather than cremated they will recycle us and continue on well beyond our death.
The microbes in your gut have never died. We can trace their lineage back over many billions of generations to the primitive bacteria and archaea. In many ways, we are just temporary housing for them, and there is a good case that we live healthily when we meet the needs of our microbiome optimally.
Managing gastrointestinal ecology and gut biodiversity requires a deep appreciation of the value of fresh organic food in season, avoidance of antiseptics and unnecessary antibiotics, a reduction in simple carbohydrates, and avoidance of preservatives and antiseptics in foods that blunt the genetic and species diversity within us.
The art of managing digestion, nutrition and the gastrointestinal tract is arguably the most difficult task for a health-care practitioner. When it works, however, it is among the most rewarding outcomes, as food becomes the friend rather than the enemy and the microbes work to give us rewards and keep us healthy.
The control of inflammation is the holy grail of modern medicine. Inflammation underpins most of the degenerative disorders such as Parkinson's disease, arthritis and Alzheimer's disease, as well as the big killer, cardiovascular disease. It shows up as chronic infection and loss of organ function, it is disabling and painful, and it is managed poorly by most modern medications, and in fact by modern medicine itself.
The medications used to control inflammation such as steroids like cortisone and non--steroidal anti-inflammatory drugs like Celebrex and aspirin are all problematic because they are unsustainable in the long term without serious injury. If you gave most general practitioners the choice of one magic pill, I'm pretty convinced that pill would be one that eliminated inflammation without adverse effects.
Inflammation used to be considered to require four signs – rubor, calor, dolor and tumor – redness, heat, pain and swelling. This is not always true, especially in so-called neuritis with the nervous system or its surrounds are inflamed but have a different type of cell in place of the inflammatory peripheral immune cells.
Inflammation is not as disorganised as it may seem, however. Dietary agents derived from animals and plants, known collectively as omega-3 fatty acids, are metabolised to wonderfully powerful anti-inflammatory and protective agents known as protectins, resolvins and neuro-protectins. Plenty of omega threes seems to be an answer to reducing inflammation and protecting the most vulnerable organ of all – the brain – from the harms associated with inflammation.
There are many other nutritional and supplemental agents, as well as the many drugs that can quench the fire of neuroinflammation, and many others that can help restore normal function after inflammatory damage.
We are very, very focused on diet and nutrition. My early training was in Nutritional Medicine, which is really the therapeutic application of nutrients in place of drug therapy. It is not the same as the nutrition learned by dieticians.
What is very clear to any practitioner who was dealt with chronic fatigue syndrome or complex and chronic illnesses is that the gastrointestinal tract is almost always a player in the process, and the successful management of gut symptoms and restoration of normal gut function is one of the cornerstones of almost every successful treatment outcome.
Different people need different type of food, but almost everyone benefits when the diet consists of fresh organic foods in season with high variety and high nutritional content, especially the trace elements and omega-3 fats found in fish.
Of course, this isn't the case for everyone, especially those requiring highly restrictive diets.
One of the jobs natural healthcare practitioners do repeatedly and well is to restrict diets to improve the health of people affected by adverse food reactions. What is equally important, however, is to restrict only those foods with solid evidence of adverse reactions, and to reintroduce all the foods necessary for optimal nutrition and to restore the joy of eating and sharing meals with one's family.
I do restrict certain foods such as gluten and milk with the person's history or family history, or functional or genetic tests point to a food-related disorder. During this time, nutritional supplements are often helpful in maintaining a high quality of nutrition prior to the reintroduction of the foods.
As described under Genetics previously some people carry genes that predispose them to fight prolamins in gluten-containing grains such as wheat, rye and barley. One rare outcome of this is coeliac disease, but the more common outcome is autoimmune disorders such as thyroiditis, type II diabetes and chronic inflammatory disorders.
I am not a fan of prolonged restricted diets especially severe restriction of healthy foods such as fruit and vegetables in low-salicylate diets. In most cases, if the diet needs to be restricted it is because the gut is abnormal, inflamed and possibly leaky,
I use probiotics and cultured foods such as kefir, yoghurt, sauerkraut and others along with short-term, specific dietary restrictions to restore gut integrity, decrease gut permeability and return the sufferer to normal joyful eating and better nutrition.
The I that is We
The final "I" in "Gemini" is … well … I. Me. The sufferer. The individual affected. The person isolated by an unnamed, complex and unexplained illnesses. Treating the "disease" is useful but insufficient. The disease takes each sufferer on a very lonely journey into unnamed regions, and each path from that desperate isolation needs a transformation from "I" to "We". A transition from the lonely desperation to support, care, love and eventual recovery.
Some, tragically, do not make it through.
This is not a question of the illness being in the body or in the mind. We are whole creatures. Whole families. Whole communities. And ultimately, a whole planet. We are tied to our external and internal ecosystems to the point that we have no clear divisions – we are what we eat, what we drink and what we breathe. Our internal environment is 90% microbes and 10% human.
We are constructs of our world and members of community. Our health depends upon relationships with others - with microbes, with food, with family and with nature. Health does not happen in isolation, and neither does recovery from illness and suffering.
Certainly, we need to manage the physical aspects of the illness such as infection, inflammation, pain, and poisoning. But deep recovery and resilience needs acceptance and compassion, care and support from those surrounding the sickened person.
Sometimes, it's the simple shared activities of movement, mindfulness and meditation. Sometimes, it's the family sitting down to organic, wholesome meals consciously and joyfully. Or sleeping well and waking early to walk or run with the sun on our skin. Sometimes, it's a pet that brings joy.
While the support of the family builds resilience and recovery, the understanding and support of friends and close community diminishes disability directly and indirectly. An employer offering reduced workload and hours, friends organising outside activities, neighbours helping with preparing meals – these make a huge difference to the sufferer, and maintain the touch and gossip so fundamental to feeling "normal"
What we doctors are slowly relearning is that complex and chronic illnesses are nothing like the acute diseases we handle so well. They do not bend to our technology. They require time, a willingness to stay with the patient – to deeply understand the patient - and to work through a dozen bad ideas to find the ones that will help rebuild health. Recovery is earned and precious. It is not cured by medical brilliance or miracle cure.
To treat the whole person, we have to go beyond the whole person. The "I" has to become "We". We are a collaboration of external and internal environments, and something of an invention of our own microbiome. We require an external environment supportive of health and recovery after illness. We need understanding, love and acceptance to return to a community from which we have become isolated when we are sick. And we need to relearn the skills, arts and traditions of humans throughout history to restore health and vigour and resilience after illness.
Why is this important? For more than 30 years I have watched and learned and helped people recover from chronic, debilitating and almost inexplicable illness. Some do well and some do poorly. Sometimes the illness is beyond the person's ability to recover (or their belief that they can recover), and we lose them forever.
And sometimes, no amount of love and support can change the outcome of the disease, but it always reduces the suffering and improves the quality of life for the person affected.
We are increasingly seeing these complex, chronic and difficult-to-define illnesses that will not submit to medical diagnosis and treatment. This does not make them untreatable, but treatment is only step one. Real recovery, or healing, needs more, and much can be gained from traditions of healing and the support of family and community.
Mindfulness, meditation, relaxation, exercise, artistic expression, joyful food preparation and meals, living clean foods, good sleep, clean air and water and the simple touch of other humans all have profound influences on health and recovery. Relearning life is not easy in the 21st-century, yet these are skills we need to recover to make our world fit for humans and humans fit for our world.
Miracles regularly occur when we get this right, when we break the isolation and alone-ness, and rediscover the power of "We".