Click here to go back to part 1 of the Wheel of Fire: Back to Pandaemonium
THE DIMMER AND THE BELTWAY
Indeed, in us all exists a wheel of fire to some degree. How tall are the flames and how quickly the wheel spins varies between us, however. The wheel of fire is not like a light switch. It is like a rheostat. Some people have a wheel that glows like a night light and that barely moves. Others are like that black hole from Interstellar.
This distinction is intuitively obvious but is sometimes missed in clinical practice. Physicians (like me) and other health professionals prefer to have either/or dichotomies. This is partially because many of our medical pronouncements are (oftentimes forced) into so-called decision tree algorithms. And decision trees are based on the 0/1 binary of computer logic gates.
In other words, in order for decision trees to work, you either have something bad or you don’t. And when you don’t, you’re completely fine. If your hemoglobin is 7.9 g/dl, you need two units of packed red blood cells. If it is 8.1, you’re fine. If your white blood cells are 10.1 x1000/cubic mm, we need to do an infection workup. If they are 9.9, however, you are fine. 25 hydroxy-vitamin D3 is 29 ng/ml? Supplement. 30? The Institute of Medicine says you don’t have to do nothin’.
But this of course is not how the human body works.
There is no fundamental difference between a hemoglobin of 7.9 and 8. That some think there is is because they’ve fallen victim to a a statistical trick developed from misplaced gaussian curves and generalizations from populations to individuals. Temperature, hemoglobin, white blood cell count, and nearly every other aspect of human physiology, and biology in general, exist upon spectra.
Of course there are terminuses of each spectra. The far end of the metabolic syndrome is insulin resistant diabetes mellitus. The far end of uric acid buildup (and an inflammatory insult) is gout and kidney failure. The far end of morbidity in general is death.
But, most of the time we exist between these terminuses. And except for some conditions, like death, even being at the terminus does not mean you will always be there (e.g. being only “mostly dead” per Miracle Max). There is oftentimes the possibility of coming back.*
*(As an aside, a brief tangent on two pathologies I deal with daily that fit this point: insulin resistant diabetes mellitus and fibromyalgia. Both of these are very curable diseases and are great instances of being on a terminus (one of centralized chronic pain and the other of insulin resistance) that is not inescapable. The reason I bring these up is that there seems to be a tremendous amount of misinformation both among physicians and pharmaceutical marketers that these diseases are “incurable”. The truth is that they are anything but.)
THERE ARE MANY ROADS TO HELL
The metaphor that I really like when talking about the metabolic syndrome, sex hormone dysregulation, and all the other stuff in this essay is, of course, the wheel of fire. Let’s mix metaphors for a minute though and imagine this stuff not just as a wheel but as a superhighway encircling a city of badness. The city can be Milton’s Pandaemonium, for instance. Or, perhaps more apropos, it could be Pandaemonium’s corporeal sister city, Washington DC. In fact, DC does have its own encircling highway. This “beltway”, or Interstate 495, is so well known, in fact, that “the beltway” is often used as a synecdoche for the city itself.
Now, let’s say you wanted to get on I-495 and do some laps around DC. As is evident from Google Maps, you have many, many options as to how to do this. There are many on-ramps to the beltway. And any one of them can potentially take you to any other point of the highway.
Likewise, there are many ways to enter the wheel of fire. Let’s look at a few just by reviewing what we know about the metabolic syndrome and sex hormone regulation.
Regarding the metabolic syndrome, we know that the most common cause is excess energy consumption. However, sleep disruption, changes in gut biota, chronic psychological stress, unlucky genes, lack of variability in diet and exercise (i.e. no hormesis or good stress), and a variety of other things also can predispose to this process.
Sex hormone dysregulation may be caused by similar things as above, as well as a few others. These include chronic psychological or physical stress, poor sleep, certain medications,way too much booze or other recreational drugs, lack of muscle and exercise, and getting old.
Thus, the other most important concept is that there are many onramps to the wheel of fire. And once you are on the wheel, it can take you to any other point on the wheel. Further, the more onramps you choose to enter (say, you have too much visceral adipose tissue, and you don’t lift weights, and you have chronic psychological stress), the hotter the wheel will burn and the faster it will spin.
To summarize, this brings us to the triple salchow of mixed metaphors. The wheel of fire is the relation of various typically unassociated but causally linked pathologies that promote one another and are bound by supranormal systemic inflammation. The wheel of fire is a dimmer or rheostat, in that it is not either present or absent, but always present in various degrees. The wheel of fire is an encircling superhighway around a corrupt city. This highway may be entered via numerous onramps. And once on the highway from any starting point, one will likely soon be taken to many other points along it.
In the next section of this essay, I will start to expand the current model of the wheel of fire. In BSSHM, I mainly discussed how sex hormone dysregulation and the metabolic syndrome are two nodes on this positive feedback loop. Well, it turns out that our wheel contains many more parts. As such, there are many more onramps and many more ways to spin the wheel and turn the heat up.
This concludes part 2 of the Wheel of Fire: The Dimmer and the Beltway.
Click here to go to part 3 of the Wheel of Fire: Walden Pond and Sharknado.