Determinants of Health

What determines one’s health is of much interest to me.  I study and evaluate this in each of my patients.  So, what is it exactly?  My esteemed colleague, Dr. Jared Zeff, whom I wholeheartedly agree and can't say it any better writes the following:

Naturopathic medicine is not simply the diagnosis and treatment of disease with natural agents.  It is a practice based upon the restoration of health.  But, what is health?  Although health is the natural state of the being, it is caused by the interaction of that being with the existing environment, both internal and external. Health is a product of many conditions, all of which help create the healthy state. Health has specific determinants, which can be studied and perceived in our patients.


The determinants of health include genetics, intrauterine influences, nutrition, patterns of exercise and rest, past illness and medical interventions, physical and emotional traumas, stresses and exposures (including exposure to microbiological agents). These are the areas in which we do most of our work. These are things, which can be addressed and modified (usually) to enhance health. It is in these areas where we find the causes of disease. Causes of disease manifest in four groups or levels: spiritual, mental, emotional, and physical.


Of these four aspects, the spirit is the center; the next layer is the mental aspect of the person, then the emotions, and the outermost layer is the physical. If there is a distortion on the spiritual level, it will create distortion throughout the system, like ripples from a stone thrown into a pond.

The knowledge of this spiritual aspect of reality is not well developed in our culture. We have no common language to discuss it. As a profession we acknowledge the existence of a spiritual aspect of the person, but do not teach a methodology to work with it. I believe that this is a peculiar phenomenon in our American culture, with our freedom of religion (or freedom from religion). Our profession must develop a language with which to discuss the spiritual aspect of healing without reference to religion.

For now, it is incumbent upon us as naturopathic physicians to acknowledge and to work in our own ways to recognize and pursue healing in this aspect of our patients’ lives. We can discuss with the patients the presence of peace and trust in their lives, their spiritual practice, or absence of it, and our perceptions of their health or happiness in these regards. This requires that we pursue our own personal spiritual development.

When a person refuses, or is unable to take those steps, which can lead, to healing from a crippling or terminal illness, this may be primarily a spiritual issue. The extent to which we can successfully address this, and to which the person can accept change on a spiritual level, will determine whether healing can occur. Illness is a great teacher. Death is not defeat. It is neither our responsibility nor prerogative to prevent death or heal illness. It is our privilege and responsibility to work with the vis medicatrix and assist our patients in their healing process.


If the location of illness is predominantly in the mind, we may not be able to rationally communicate with the person. This significantly limits our ability to work with that person, especially in the absence of a naturopathic in-patient facility. We can recognize health or illness on this level in our patients by their ability to rationally communicate, their mental clarity, memory and other functions of the mind. We can approach these problems like any chronic illness.

The first signs of improvement in treating chronic illness are often enhanced mental clarity and memory along with an increase in energy. We have specific tools to work in this sphere. Beginning with improvement of diet and digestion and stress modification, we can generate initial changes in and set the stage for other improvements to follow. In addition, there are a variety of medicines, which target the mental function. We are rich in therapies, which applied in the order which healing dictates can produce marvelous results.


The emotional body of the patient is a transient expression of the more constant spiritual center. Laughter, sadness, anger, depression and other emotional states, which come and go in appropriate response to the variety of life, are not illness. There may be causative elements of illness in the extreme or prolonged emotional states, which usually accompany emotional trauma, such as divorce or childhood abuse. This may be a gateway to spiritual damage, or simply a transient, though dysfunctional state. It has been well demonstrated that depression, for example, can negatively affect the immune function. We recognize that the cause of illness may center in this area. We look for it and work with our patients to correct it.


Of the physical causes of disease, the generally most significant and most important to address initially is diet and digestion. This is the largest and most constant physical input into the organic system, and the one upon which the maintenance and continuation of the organism depends. If digestion is disordered, illness will result. If illness exists, digestion and diet must be optimized for any other correction to have its best effect. If diet is improper therapy will work as well or as permanently as it could otherwise. Therapeutic nutrition is the common denominator among naturopathic physicians. We all use it, although approaches may be different. 


“Toxemia” is an old naturopathic concept involving the fundamental disease-causing effects of toxins generated from dysbiotic processes in the gut and fed by improper diet and digestion. Toxins are absorbed into the bloodstream and become the basis of chronic irritation and inflammation in the body. This may be, for example, a basic cause of arthritis or other chronic, inflammatory disease.

The maldigestion, which creates the toxemia generally, has two causes. The first is diet. This includes everything from food selection and methods of preparation to the environment in which the person consumes their meals.

Stress, or perhaps we should say dys-stress, both physical and psycho-emotional, is the second major cause of acute and chronic illness. Stress negatively affects digestion. Digestion is a parasympathetic event. When under stress, the sympathetic nervous system becomes dominant is stimulated. Stress increases the cortisol and epinephrine levels in the blood. Cortisol and epinephrine cause a decrease in blood flow to the digestive apparatus via vaso-constriction while increasing blood flow to the brain and muscles. Digestion requires significant blood flow to operate effectively. Without it, the juices and enzymes necessary for adequate function cannot be produced. This results in toxemia, and a progressive weakening of digestive function. The reduction of toxemia is fundamental to healing. This cannot be over-emphasized. It is also a historic basis of naturopathic medicine.

Stress and diet rank at the top of our list of physical causes of disturbed health (especially in chronic disease) as well as of susceptibility to acute diseases. Other causes of disease also need to be understood, evaluated, and dealt with.


Without doubt, there are microbial causes of disease. Which is more important, microbial pathogenicity or host resistance? Both play a role. There are some pathogens, which are extremely virulent. Most, however, require “fertile soil” in which to grow. It is rare and unusual that the best treatment of an infectious illness is antibiotic therapy. This can be understood from an analogy of flies and garbage.

If one continually throws garbage out the kitchen window, there will eventually be flies to contend with. One can deal with the flies by spraying poison on them, and even spray the garbage pile itself. This is like using antibiotics. Or, one can clean up the garbage. Not only will the flies go away, but also the kitchen will smell better. This is the naturopathic approach. Clean up the garbage. If you do, the flies won’t come back when the “poison” wears off. And the flies won’t build up a resistance to the poison either.

“The naturopathic physician seeks to treat the causes of disease, rather than to merely eliminate or suppress symptoms.” Remember, fever, inflammation, and even infection are not the disease; they are the result of disturbances in the system which can be corrected. This is the art and science of naturopathic medicine. Correcting these disturbances by understanding what determines health is the first step in restoring health and eliminating the basis of disease. Failure to do so reduces the efficiency of any attempt to cure by other methods.

Also, remember the order of the healing process and the appropriate therapeutic order. First identify and remove causes of illness, then re-establish healthy conditions, stimulate the self-healing mechanisms, supplement or support the affected systems of the body, and lastly, correct the structural integrity. If we proceed in this order, it is my experience that we enhance our results significantly.

It is a fallacy to assume that this takes longer than what is often thought of as more direct action against disease such as antibiotic therapy. One can see significant results within hours of beginning such work. Naturopathic medicine does not take longer than conventional medicine. It is not only more efficient, but generally acts faster and more permanently, and is health generating and sustaining as well.

I invite you to make an appointment with Dr. Vingelen today to restore your health!