25 Jan WHAT IS NORMAL HEALTH?
Editors Placid A. Bone, MD and George H. Bone, MD
Storms are blowing over the Gulf of Mexico, up to our mid-Atlantic region of Prince George’s County, Maryland. The normal of our daily rhythms have changed over the past several months. At I C Care we’re often asked what is normal health. Is the patient asking what is normal for humans or normal for me? Looking at mineral deficiencies and patient vitals, let’s spend some time reviewing examples of how we define normal bodily functions and when it is useful in patient care.
When we speak of normal we have to separate norms for a population, then determine a norm for an individual in the population. Defining normal for an individual is achieved through trial and error, and listening to the patient.
NORMAL IS HARD TO FIND UNLESS YOU KNOW SOMEONE VERY WELL
- CURRENTLY A NORMAL BLOOD PRESSURE IS LESS THAN 120/80
In Western medicine, normal is a range of numbers for a given population in a certain state of health. The history of a normal blood pressure has changed from 160/100 to 150/90 to 140/85 to currently 120/80. The problem we have in interpreting results is that nothing tells us what is the number for a given individual. If the individual happens to be outside of their norm we would never know because we don’t know what is normal for them we only know what is normal for the population.
THE INDIVIDUAL NORMAL IS ALWAYS AN EXPERIMENT OF ONE
- DOES A NORMAL PERSON HAVE TWO BOWEL MOVEMENTS PER DAY ?
Normal parameters are statistical numbers for large populations and are not individual numbers. Doctors use population numbers to make individual decisions. We know babies have a BM after each meal but is a stool once every two weeks normal for an adult? Only by further questioning can the real number be defined.
We force the individual to fit into the population norm when the individual norm can be totally separate. The optimum range for an individual quite often is more tightly defined.
There are many common mineral deficiencies like magnesium, zinc, but let us focus on potassium levels in the body as a simple example to find normal. Further more, the more complex deficiencies such as water and iodine are harder to define normal need.
- NORMAL POTASSIUM RANGES FROM 3.5 TO 5.0 meq/L
The first stage of knowledge for personalized medicine is found at the endpoints of every range. A potassium of 3.6 meg/L might be normal for me but if you are having leg cramps at this same number then something might be off. After one week of taking potassium your level increases to 4.0 meg/L and more importantly your leg cramps go away. As your doctor, I have gone from the population to the individual. This medical recommendation is a hard leap, only achieved by listening, treating, and observing the response to treatment.
- A NORMAL THYROID MUST USE IODINE TO MAKE THYROID HORMONE
Iodine deficiency is one of the most common mineral deficiencies in the world. The thyroid gland actively takes up iodine because it has the greatest need. But many other organs also require iodine e.g. muscles, skin, bone, lungs, GI tract, testes, uterus, breasts. The latter only receive iodine passively. The thyroid gland actively takes up iodine, and the others take up the remaining. All the studies to date look at iodine required for optimum thyroid function to prevent goiters but the level needed for other tissue function optimally has received very little attention.
A GOITER AND HYPOTHYROIDISM ARE TYPICALLY FROM A LACK OF IODINE
Individuals are further made deficient by foods or beverages that bind iodine for example bromine that is used in the processing of flour to make bread or chlorine in water. The bromine or chlorine competes with the iodine, and is preferentially uptaken in the GI tract in place of iodine further making the individual iodine deficient. Also eating a lot of cassava (yucca), which contains cyanide, also competes with iodine. Which is why in many parts of Africa where there are cassava rich diets iodine deficiency is very common.
It is too costly to measure a total 24 hour urine for iodine just to prove iodine deficiency in each individual. Especially because we know that if someone lives more than 25 miles from the ocean and is not taking supplemental iodine they are inherently iodine deficient. Because you get iodine from eating plants grown in iodine rich soil so the further from the ocean you go there is less iodine. The government is well aware of this phenomenon so we add iodine to table salt. Persons who have to reduce or avoid salt intake are at risk for iodine deficiency.
- THE NORMAL AMOUNT OF WATER TO DRINK IS 6-8 GLASSES DAILY?
Our bodies are 68% water and unless you fix the water problem it is hard to appreciate the dynamic equilibrium or balance of the nutrients dissolved in water. Normal for the individual can be determined by tuning into the still, small voice of the human body – hearing this silent speech is another hard leap. Once you start listening, it is easy to understand that one of the most common deficiencies in the body is water.
What is normal for an individual is a function of what work you do, what kind of food you eat, how much you sweat, the quality+type+amount of beverages…. All of these bits of information are required to determine what is normal for the individual. So start with “6 to 8 glasses of water” and then listen to that silent voice.
Avoid sugary beverage to fight dehydration and hunger. What’s a diuretic?! Tea, Cola beverages, Coffee, Alcohol.
When you starve the body of water, or take diuretics, or drink sugary beverages (which increase loss of water), one becomes dehydrated. This lack of water throws the entire organism into a disequilibrium and into a state of dis-ease.
WISE MEDICINE IS FINDING YOUR NORMAL
The practice of medicine is to constantly take population norms and apply this to the individual. This is the process of decision making also known as disease diagnosis. The mistake is to forget that this is patient care.