The Five Levels of Health

by Lendon Smith, MD

from the book

Feed Your Kids Right

The word he, used in these examples and throughout this book, is of course the generic use still a kind of communication shorthand-and almost always really means "he or she."

The theory on which this book is based is that optimal nutrition will maintain a person in health that is optimal for his or her particular genetic endowment. We could all be healthier than we are, and the failure to achieve an elevated plateau is directly proportional to the degree and significance of our various nutritional deficiencies. I am proposing here that the right food and appropriate nutritional supplements can maintain and improve health and forestall the development of illness.

Picture a somewhat arbitrary division of humans into five levels of health, to be described shortly. As you read on, see where you and your family fit in this picture, and consider what you might safely do to move your whole family up into a more comfortable, disease-free existence.

At the top level a person is at peak efficiency and well-being. At the fifth level he is sick enough to be hospitalized on intravenous fluids, three medicines, an antibiotic or two, maybe oxygen, even catheters. We all know what the sixth level would be. Most of us live on the second to fourth levels, often going up to a higher level but unable to remain for long in an enhanced state of health.

Sliding down through the levels is all too easy if a combination of stresses and unlucky events occurs. Consider a baby, nine months of age, who has cut four teeth (a stress). His mother decides to stop nursing him (a stress). He develops a cold. In four days he has 102? fever and an earache (a stress). His doctor gives him a shot of ampicillin (a stress). After taking additional medicine orally for five days he develops diarrhea (a stress). His appetite is off (a stress). He can only drink sugar water (a stress). He seems symptom-free for three weeks (no stress). The weather changes or his babysitter sneezes on him; he gets a fresh cold (a stress). He gets another ear infection, this time accompanied by a febrile convulsion-a real stress. He gets a spinal tap, more antibiotics, and is placed on phenobarbital to prevent a recurrence.

He has gone from perfect health ( Level I ) to Level III in six short weeks. Prophylactic medicines prescribed by the doctor will keep him from Level IV ( tubes in ears, adenoidectomy, allergy tests). A stress-free period of recovery and proper care should bring him back to Level I.

These levels are not clear-cut. Health states are a continuum; one thing leads to another-for better or worse. The more you sink, the more the doctor is required. The better you maintain your body, the less likely you are to experience bouts of illness.

Your family doctor can tell you what you need to know about the biochemistry and genetic predispositions of your family. Armed with this knowledge, you will be able to follow an individualized program of nutrition and preventive maintenance, so each of you can live at an optimum level of health.

Level I

This infant grows to adulthood free of illness, rashes, gas, headaches, fatigue, depression, insomnia. He* came from a stress-free, comfortable, full-term pregnancy and easy delivery. He laughs and smiles more than he cries and frowns. His hair and nails are glossy, not brittle, require a minimum of care, and his scalp is smooth and clean. His bowel movements have an acid odor with little or no putrid, nauseating smell. He's never constipated (well, hardly ever) nor does he have loose, sloppy, green BMs. He does not bruise easily nor can one raise a wheal easily by scratching his skin. When he cries his nose runs clear; he breathes easily with no hyponasal twang to his voice. He sneezes, snores, and coughs rarely. No blood is noticed from his nose unless injured, and then it stops quickly.

He cuts teeth easily. He handles weather changes, teething, going to school, learning new skills, athletic exertion, and other stresses with a minimum of psychosomatic symptoms. He can eat many foods and occasionally even junk food or sugar without a headache or fainting or fatigue. His permanent teeth are even, free of cavities, un-crowded, and there is room for his wisdom teeth. No orthodontia is needed.

He is likely to come from a family that seems calm and accepting. There is little or no obesity, diabetes, allergy, alcoholism, schizophrenia, or depression in his family background. He is more likely than not to be brown-eyed (American Indians excepted) and he tans easily.

He works up to his ability in school, is not easily distracted, learns to read easily, finishes assigned work, is usually compliant and easygoing. He makes friends easily and has a pleasant personality. He is adroit and coordinated. He is neither thin nor fat.

He has few extremes of emotional response-he cries or laughs appropriately. He enjoys doing things for others.

He sails through his developmental levels in physical, psychological, and cognitive growth as if he had read the charts. He does not prolong bed-rocking, thumb-sucking, hair-twisting; he is able to abandon such behavior as he matures without fuss. He is easy to toilet-train; he almost seems to do it himself when ready for it.

He enjoys pleasing his loved ones. He can also entertain himself. As he grows he can even laugh at his own human frailties. If he experiments with drugs, it is only because his peer group suggests it; he abandons them because he finds his drug-free existence more comfortable.

He is a satisfactory, fun-to-have-around child. A joy. He even remembers your birthday and anniversary.

Level II

There is nothing very wrong here, but the differences suggest a slippage that, if unchecked, could slide on down to disease and misery. Remedial action is called for. He still laughs more than he cries and in general is a satisfactory baby, child, adolescent, adult, parent, but he has occasional moments of allergy, discontent, moodiness, sickness. His nose may run when be is on the wool rug for more than three hours. He doesn't sleep through the night until three months of age. He lollygags over breast or bottle and vomits once or twice a week when handled by a stranger. A cold develops only if someone brings it home-maybe two or three times a year and clears rapidly with nose drops and antihistamines without accompanying ear infection.

Bouts of gas and fussiness are rare but real and are dispelled by tea, massage, or a glycerin suppository. He is not completely satisfied on the breast and sometimes has gas if his mother eats beans, garlic, or onions. If overfed he will vomit. An occasional BM may stink.

His development matches the standard charts but he is occasionally frustrated because he crawls under a table and can't get out. He loves cuddling. He insists on sucking or rocking and needs a favorite stuffed toy at bedtime. Separation anxiety comes early-at seven or eight months-but he can be distracted out of it.

Teething may be accompanied by a fever (100? to 101?) but aspirin is curative; no disease follows. He gets roseola but is not "sick": he just feels warm and is irritable for three days and then has a body rash and resumes smiling.

He has food preferences but can be talked into eating almost everything except liver and spinach. Rashes appear (cheeks, face, buttocks) with some new foods but disappear in a day or so. He has a hard BM only with too much rice, applesauce, or bananas.

Temper tantrums are short; he gives them up when his parents turn their backs. In a month he finds better ways to express himself: "No!" He cruises about the house touching things but seems careful and looks to his parents for approval. If they say no, he understands and does not again touch the forbidden object.

He has little trouble getting toilet-trained: a few dry runs and false alarms and several accidents. Girls are trained at eighteen to twenty months and boys by two and a half to three years.

Only one attack of croup per winter and only one strep throat in every two or three years; the former is assuaged with steam in two nights and the latter responds nicely to penicillin.

School is a little scary for a day or two but when he gets his bearings he is cooperative, a leader, and has fun. He learns easily but occasionally goes off the page and writes on his neighbor. He is sorry if be hurts someone. Only a few accidents, and never suturable cuts or concussions. He is careful with toys. Never sticks a bean up his nose. He waits to ride a bike until he is sure he can, then he does it easily. Remembers danger when warned.

Enjoys sweets but has no obvious food cravings. Accepts punishment if fair. Goes to bed with only a little reluctance.

Plays cooperatively with others. Likes to win but accepts a loss cheerfully. Doesn't care if chosen fourth when sides are picked. Defends self in a fight but will not start one. Mood swings are slight and evanescent. Will not think of mean things to do to the losers in his class and joins in only reluctantly if his peer group picks on someone.

Growth is even. During ages seven to twelve he enjoys his parents as much as his friends. Invites a friend over as if proud of his home and family. Would prefer certain toys or games on birthdays but appears pleased if relatives give shirts and pajamas.

Only rarely does he awaken his parents because of nocturnal fears; may wet bed only after an exciting party or scary movie. Does his fair share of chores within twenty-four hours after the request, rarely complains that he is a slave.

Adolescence is generally smooth since he has enough supportive friends and hobbies. Only twenty pimples in six years. Never gets mononucleosis. Only an occasional stomachache if he forgets breakfast or before a big game. Good at team sports; cooperative. A few muscle cramps after exercises.

Sneezes for a week during pollen season. Gets athlete's foot but it is easily cleared with an over-the-counter fungicide. Gets sweaty palms and rapid pulse on his first date. Masturbates once or twice a week and feels guilty but doesn't lose sleep over it. Laughs when friends say he will get hair growing on his palm. Smokes off and on; enjoys beer with friends.

Level III

The mother of the child in this category usually had a stressful pregnancy: nausea and vomiting, mild toxemia, spotty bleeding, prolonged or early or Caesarean delivery. The baby may have been premature, was slow to breathe, had to go into the incubator, perhaps also needed oxygen. Because of these factors the mother and baby are not allowed to participate in early, important mother-child interaction. She may be too weak to nurse and he may be too tired to suck, so the "helpful" nursery team puts him on cow's milk and she dries up.

He picks up on weight and strength and things go well for about two to four weeks, when colic, eczema, wheeze or vomiting, gas, and diarrhea push a barely Level I baby into Level II or III. The doctor is summoned and may be able to prevent a further decline to Level IV. But these are the babies who get colic medicines, antihistamines, antibiotics, ointments, and milk changes and whose families need tranquilizers, sedatives, and aspirin.

These children are touchy, often uncuddlable-as if the world is too close. They may fight back or occasionally withdraw, suck their thumbs or rock the bed with a determination that suggests they are trying to block out a sensory overload. We want to cuddle and comfort them, but if we get too close they arch away or stiff-arm us or get so tense they will vomit the ultimate in body language, indicating rejection of our advances.

This hypertonic baby is the one who should have been nursed, the one most likely to have come into the world with exhausted adrenal glands and, as a consequence, the one who would most likely develop an allergy to cow's milk. As noted above, one stress leads to another and he hovers between Levels III and IV. If the parents can hold him together he may outgrow his problems; but each new stress will surely overburden his weak defenses. Repeated infections, intestinal upset, rashes, allergies force the parents to overprotect him and make a "hothouse plant" out of him. Hypochondriasis and constant navel-gazing seem to be his lot.

He overreacts to separation; has violent temper tantrums over the slightest insult; is noncompliant in eating, toilet training. He feels put upon. Birthdays, outings, surprises are overwhelming invasions of his privacy or opportunities to become a tyrannical monster. He is accident-prone, a bull in a china shop, shows no remorse if he hurts someone, does not seem to profit by mistakes, and cannot seem to comprehend parental instruction.

He is either terribly shy or a persistent approacher-he cannot ignore unimportant stimuli. Either environmental stimuli overwhelm him and he retreats in fear or has to attack everything that appears in his environment. Everything must go his way-no compromise, no give and take-and when sick he expects to be waited on hand and foot.

He has few friends in school, but he may be the class clown. He makes the rules for the games; he needs to win and will cheat to do it. He is a Jekyll-and-Hyde type of person, showing wild swings of mood. He can be very affectionate if he wants something, pouts or storms if he gets only a fair share.

He has persistent allergies. He needs antihistamines and occasional shots of cortisone for bee stings or bad bouts of asthma or a completely plugged nose during pollen season. He is likely to have had his tonsils removed and had tubes in his ears; he may have been on prophylactic antibiotics to suppress infections. His attacks of colds usually last longer than those of his siblings and are more likely, to go into secondary bacterial infection.

Intestinal flu exhausts him. He is more likely than not to be hospitalized when sick because home nursing care never seems to be adequate. He dehydrates easily when sick.

His nights do not seem restful. He may resist going to bed. He awakens screaming with a night terror once a month, or he sleeps deeply and wets the bed. He is a grouchy bear in the morning and ruins whatever cheerful interaction his parents try to observe at breakfast. He often refuses breakfast.

You know that if he would eat properly he would feel better. It almost seems as if he enjoys feeling punk. He is sallow and usually has dark circles under his eyes. He gets head- and stomach-aches easily, especially if he is asked to do a chore. He may wear a jacket when everyone else is comfortable in a shirt. When adults speak to him he sits impassively with his arms folded on his chest. He acts as if he wants people to dislike him.

Adolescence is difficult. He tries alcohol, cigarettes, and pot at eleven or twelve years of age and drugs at thirteen or fourteen. His friends are often the losers.

Acne is moderately severe and persistent. His hair is stringy or greasy. He doesn't seem to care. He has a bad self-image. Teachers don't like him and hope he will drop out of school; he hopes he will be expelled because he hates school anyway.

It takes a lot of social, parental, psychiatric, and medical help to keep him from juvenile delinquency. He could slip easily into a lifetime antisocial commitment.

Level IV

Individuals unfortunate enough to qualify for this category require almost constant medical attention: daily drug therapy for epilepsy, diabetes, cystic fibrosis; gamma globulin and antibiotics to ward off infections; weekly allergy shots; anti-leukemia medicines; surgery for congenital anomalies, twisted bowels, kidney malfunctions, tumors, or blood clots; cortisone on a daily basis to control arthritis, colitis, nephritis, asthma. All attest to the seriousness of this level of trouble.

For many children, however, the bodies may have arrived at this level but the emotional and intellectual level may still be up at the I and II area. Some have bodies and general physical health that qualify them for Level I or II but their psyche is at the fourth level: depression, phobias, extreme hyperactivity, belligerence, migraine.

Level V

This category contains the bedridden, terminally ill, extremely retarded or malformed-the child about whom doctors become very depressed. We would like to help, but the conditions seem irreversible.

These levels are merely illustrative of a continuum of behavioral characteristics. Your child need not have all the characteristics of each level to force a label or cause needless concern. These profiles provide me with a general guide as to how heroic I must be with nutritional supports. Some children in Level II or III need only diet changes; others in Levels IV and V would more likely need high-potency vitamins, even injections in high doses to reverse the rapid slippage.

If school authorities want to stop discipline problems and vandalism in the classroom, they must do away with sugar and junk foods in the hails and close the candy stores within two miles of the school.