Complexity and Human Health – Part 2, Complex System

What happens when we get hyper-focused on individual components of any particular health-conscious behavior? Let's explore two health-related examples to see the answer.

Back in the Introduction, I used an example to help you get thinking about complexity as it relates to your health-conscious decisions. Let's bring this example back into play (along with one other), digging deeper into it now that you have a better understanding of simple vs. complex systems.

Before we do, I want us all to be clear on why we are walking through these examples. (Seriously, I urge you to pay attention to the next three paragraphs so that you take in this information and later apply it in a way that aligns with The Reprogrammed Systems Approach).

The idea, for now, is to use these examples as a way to understand the deeper complexity at play within any health-based decision. The idea is not to examine these cases with any sort of intention to come up with a right course of action. The task that is attributing degrees of power for each factor and applying it to any individual's life is not our task. You can save that task for another time if you wish. For now, I bring up these examples while simply listing different contributing factors.

As for when the time comes to think about taking action for your own self... remember, our approach is to release the need to control all these little details. To be able to make healthier decisions we need to understand that this greater complexity exists. However, we will have to take care that we are not getting bogged down in all the mechanisms that could be at play.

Getting bogged down in the details is what prevents action that leads to results. We need action, and we need that action to lead to beneficial results. So, we move forward by examining these two examples with the intention to appreciate the greater complexity at play. Then, in the next lessons, we'll get into how we can take action that leads to beneficial results.

Examples:

Example 1: Saturated fat

Most of us have been taught that LDL cholesterol is "bad cholesterol" and that saturated fat is "unhealthy" because consuming saturated fat leads to an increase in LDL-C.

The reason for this is LDL's role in the progression of atherosclerosis, in which plaque builds up in an arterial wall.

The mechanism: plaque may build up when cholesterol gets deposited in the arterial wall. This cholesterol is delivered via lipoprotein particles, one of which is termed LDL (low-density lipoprotein particle).

And, since the consumption of saturated fat tends to increase the cholesterol contained within LDL (LDL-cholesterol) should we avoid saturated fat to avoid plaque formation and atherosclerosis?

Maybe, or perhaps we need more information.

For starters, let's look at plaque formation in greater detail:

• why is there a tear in (or other damage to) the arterial wall that enables the LDL particle to enter in the first place?
  • damage due to chronic inflammation
  • damage due to high blood sugar
  • damage due to high blood pressure
• what about the other lipids at play?
  • what other lipids are being consumed and what is their structural integrity? Are they holding their structural integrity or becoming oxidized (at which point they may react with tissues or other biomolecules, contributing to the progression of the atherosclerotic plaque)
• what about the structure and integrity of the LDL particle itself?
  • there is solid data demonstrating that the size and density of the LDL particle contributes to the power that each particle has to contribute to the atherosclerotic plaque
  • what about the other biomolecules being transported in that particle (e.g., other lipids) - these may have the power to contribute to the atherogenicity of that particle
• what about the structural integrity of the plaque?
  • higher blood pressure can lead to damage to the stability of the atherosclerotic plaque

Remember, the point here is not to understand every possible mechanism, by which an atherosclerotic plaque develops. Our goal is to move away from breaking down the system and moving away from attempting to understand every little detail.

Rather, I walk you through this exercise because I want you to appreciate the fact that there is so much more at play than just the one particular factor (LDL-C) has on the development of one particular disease.

Now that we understand the complexity of this one pathophysiologic condition, let's switch things over to looking at the complexity of dietary components.

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In any particular food there are a variety of nutrients (and other components):

• When we make a decision to avoid a particular type of food (e.g., a steak or butter), we are avoiding the saturated fat, but we are also avoiding all the other nutrients in that food.
  • And, when it comes to our health, those other nutrients (the rich protein in steak, the fat-soluble vitamins in a good butter), we are making the choice to avoid those nutrients.
• When we make a decision to avoid a particular food, we are likely choosing another food in its place
  • And, when it comes to alternatives to steak and butter, you could be choosing an option that actually contributes to these other factors that drive the progression of atherosclerosis
    • Consuming less butter and more vegetable oil - you could be contributing a larger volume of pro-inflammatory, oxidated lipids
    • Consuming less butter and steak and consuming more refined carbohydrates and sugar - you could be creating a state of full dyslipidemia, driving up LDLand triglycerides while driving down HDL.

What about saturated fat, itself?

Saturated fat is a particular type of fat, composed of a chain of carbons that are saturated with hydrogen atoms. Because of this, there are no double bonds and the molecule is highly stable.

It's worth noting that saturated fats come in different forms, defined by the length of the fatty acid chain (the number of carbon atoms). This is worth noting because, as it turns out, only some saturated fats actually have this property that is linked to raising LDL-C!

So, right away, we see that the generalization that saturated fat increases LDL-C is lacking in complete validity. Only some saturated fats have this property, so it would be unhelpful to avoid all foods containing any sort of saturated fat based on this one property.

Once again, the point here is to understand that whenever we make a health-conscious dietary decision, there is so much more at play than what we are thinking about. Because of this, is it really the most effective method to base decisions on precise, reductionist information?

Let's take a look at one more example, this time pulling in both nutrition and exercise.

Example 2: Judging a food (or exercise) based on the caloric value

I know we are all familiar with this one: if you want to manage your weight, simply balance the number of calories you consume with the number of calories you burn through exercise.

And, since weight is roughly correlated with various health outcomes, it translates that if you want to be healthy, you should balance the number of calories you consume with the number of calories burned through exercise.

Simple, right? Again, that's the problem.

Calorie balance is an equation taken from the First Law of Thermodynamics which describes how, since energy is conserved, any difference between the energy entering into a system and the energy leaving a system must be accounted for by the energy within that system. This is all to say:

Energy In - Energy Out = Change in Internal Energy

This equation holds true for any system. The question is not the validity of the theory nor equation.

The potential problems arise with its application to weight loss and health.

By definition, if an individual wants to lose weight, a calorie deficit must be achieved. This means that individual must consume fewer calories than are burned. Does this mean that the individual should be hyper-focused on calories at the exclusion of other factors?

Let's take a look at three different situations:

• an individual tries to force him/herself into a calorie deficit by eating fewer calories and as a result, that individual is lethargic.
  • that individual may now have no energy to exercise and may have a lowered metabolism, leading to a low value for "energy out"
  • as a result, no weight loss happens and the individual goes through life with low energy and other debilitating symptoms (perhaps brain fog or headache)
• an individual forces him/herself into a calorie deficit and as a result, that individual loses weight.
  • however, that individual's body receives the signal that nutrients are scarce and epigenetic changes occur, leading the individual to naturally burn fewer calories
  • later on, that individual eats the same low amount of calories, but is burning fewer calories and starts to gain the weight back
• an individual is feeling lethargic so he/she decides to eat more nutrient-dense foods
  • this individual now has more resources to go be active during the day, building up a strong metabolism that effectively burns off the excess fat stored away

See how, in each situation, the individual's immediate manipulation of the calorie balance equation is different, yet the results differ because different factors come into play?

• the first individual focused on lowering the "energy in" term
  • this led to less energy and a decreased "energy out" term, likely harming his/her health
• the second individual focused on lowering the "energy in" term while increasing the "energy out" term
  • this led to a temporary energy deficit, but long term led to a decreased "energy out" term, likely harming his/her health
• the third individual focused on increasing the "energy in" term
  • this led to an increased "energy out" term and improved overall health (perhaps losing weight along the way!)

Once again, the point here is not to shut down calorie balance as a framework for losing weight. Many individuals have used it to lose weight and improve health outcomes.

The point is that the decision to consume fewer calories and/or exercise to burn more calories is only one piece of calorie balance, not to forget to mention that calorie balance and an individual's weight is only one piece of the greater health of that individual.