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"Out of intense complexities intense simplicities emerge." -- Winston Churchill

Synergy occurs when 2+2 add up to more (or less) than 4. This idea is important in health care for combining treatments carefully and thoughtfully. This point relates both to prevention of disease and coordination of treatment options for people with many different chronic conditions. You put multiple factors together, and they create something bigger ? or at least ?different? ? from what they could do on their own.

Synergy can work for good or bad. Different factors can be synergistic, additive, or even antagonistic (working against each other).

That is, in generating health problems, new research is showing more and more that you might be OK with exposure to one risk factor, but two or more risk factors together really increase your risk of a negative outcome (illness).

Recently, for instance, a study just published in the Journal of the American Medical Association showed that mice who were exposed to both polluted air and a high-fat diet had a lot more plaque build-up (over 40%) in the largest artery in the body, the aorta, than did mice who had no pollution exposure and a good fat diet (13%) or just a high-fat diet by itself (26%). This kind of interaction of pollution and high fat in the diet raises the risk for heart disease down the road.

In other words, the more risk factors that can be reduced, the better off you are likely to be. In practical terms, this can mean taking a good look at the location of where you live and work. Urban environments tend to have the greatest pollution of particles in the air, which is the kind of air pollution studied in the recent article. People who have long daily commutes to and from work or who live or spend many hours a day near busy traffic areas are going to be at greater risk from particle pollution in the air from vehicle exhausts.

What if you just can't change your location for now? Then at least take a serious look at the fat content of your diet. Both the amount and the type of fat may make a difference for different health risks. A diet that contains healthier fats (with lots of omega-3 fatty acids, as in wild Alaskan salmon) and/or the olive oil kinds of fats as in the Mediterranean diet, may be a way to transition away from the worse kinds of fats (the saturated variety) and hopefully too high a fat content in your diet.

General public health recommendations are for consuming less than 30% of your calories from fat and to emphasize the healthier types of fats (e.g., from olive, canola, or soy oils, non-hydrogenated versions). Lower fat and the right kinds of fat may lower your risk for illnesses such as heart disease and certain cancers.

Another place where synergy is starting to come into play is in food additive research. A new study looking at the toxicity of four common food additives ? two different food colorings, aspartame, and L-glutamic acid ? showed that combinations were toxic to developing nerve cells, whereas the isolated items by themselves were not.

We don't know for sure that these findings will translate into worries past the test tube stage, but they raise concerns. Our whole conventional way of thinking about toxic risks is to test each risk by itself. The trouble is, the world is all jumbled up together ? and things do combine. We know very little about what the combinations may mean for our long-term health outcomes, even if the single ingredients are OK.

In the real world, all of us are exposed to more than two factors at a time. The research is limited because of the difficulty in people juggling in their minds more than two factors. But reality is complicated. Complex, really. So, we don't know much at all about the interactions of different types or classes of factors for good or bad in our everyday lives.

So, synergy research for bad outcomes (illness) make us wonder if combining more than one treatment option might often produce larger benefits than staying too focused on only one thing. That is why the whole systems approach to making your health care decisions makes sense.

Sure, you have to start one thing at a time or it gets too overwhelming. But you can build on each step that you do take. For example, if you have chronic pain, would a combination of osteopathy or chiropractic or massage AND acupuncture help you more than staying with just one alone? Practitioners often claim that these kinds of benefits occur, but very little research has examined this possibility. We'll keep our eyes open for studies on package of care and let you know as they come out.

There is some research in diabetes prevention that hints at the advantages of a full package of treatments together versus a single drug. Intensive lifestyle coaching reduced the risk of developing Type 2 diabetes mellitus (the most common type, especially in persons who are overweight) by 58%, whereas the drug with usual lifestyle suggestions only helped reduce risk by 31%. These are in comparison with just lifestyle suggestions alone. So, don't count on a drug alone to do everything possible in solving the complex problems that come together in chronic disorders and diseases.

In short, prevention and treatment can be both simple and complex. Knowing how to use the synergy concept empowers you to make more informed choices about your lifestyle and your treatment.

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