This piece continues from the earlier installment of Stones in the Body: More Frightening Than Cancer (Yoon Jong-won). The body, figures, and citations follow the manuscript as written.
A (Acidosis) Trigger Gate: Bone Is Sacrificed to Neutralize Acid
The gate of A opens when the body tilts toward "acidic."
The pH of the blood must be maintained between 7.35 and 7.45. If it leaves this range, enzymes do not work properly and cell function collapses. That is why the body manages blood pH with extreme strictness.
The problem is that the life of modern people produces acid.
Consider a high-protein diet. When protein is broken down, acidic substances such as sulfuric acid and phosphoric acid are produced. Vegetables and fruits provide alkaline substances that neutralize these. But what happens if you eat a lot of meat and few vegetables? Acid accumulates.
Consider processed foods. Carbonated drinks contain phosphoric acid. Processed meats have phosphates added to them. These raise the acid load in the body.
Consider alcohol. When alcohol is broken down it becomes acetaldehyde, and as this is broken down again, acidic metabolites are produced. When you drink too much, acid accumulates.
Consider a decline in kidney function. The kidney is the organ that excretes acid. When the kidney weakens, acid excretion decreases. Acid accumulates in the body.
When acid accumulates, what does the body do? It must neutralize it. To neutralize it, alkali is needed. Where is the largest reservoir of alkali? The bone.
The calcium of the bone is stored in the form of hydroxyapatite. When this dissolves, alkaline substances are released along with calcium ions. This alkali neutralizes the acid in the blood.
The gate of A opens like this. Bone is sacrificed to neutralize acid. To catch the acid, the bone is dissolved.
4. H (Hypoxia) Trigger Gate: Energy Shortage Collapses Calcium Regulation
The gate of H opens when cells cannot receive "oxygen." Cells use oxygen to make ATP. ATP is the energy currency of the cell. All cellular activity requires ATP. But when oxygen is short, ATP production decreases.
Calcium homeostasis also depends on ATP. The cell must keep calcium concentration low. The calcium concentration inside the cell is ten thousand times lower than outside the cell. To maintain this concentration difference, calcium must be continuously pumped out. The thing that does this work is a pump called Ca²⁺-ATPase.
To run the pump, ATP is needed. When oxygen is short and ATP decreases, the pump stops. When the pump stops, calcium floods into the cell. Calcium is overloaded inside the cell.
Intracellular calcium overload is a catastrophe. When calcium piles up in the mitochondria, the power plant stops. Calcium activates enzymes that break down the cell itself. The cell is damaged and dies.
The H (Hypoxia) trigger gate can open through several routes.
If you have lung disease, oxygen is not absorbed. Patients with COPD, patients with asthma, and patients with pulmonary fibrosis are in a state of chronic hypoxia.
If you have anemia, oxygen is not transported. When hemoglobin is lacking, oxygen cannot be carried. Iron-deficiency anemia, vitamin B12-deficiency anemia, and anemia of chronic disease all cause tissue hypoxia.
When circulation does not work, oxygen is not delivered. If you have heart failure, the heart cannot push blood out properly. If you have peripheral vascular disease, the vessels are blocked and blood does not circulate. If you do not exercise, the muscle pump does not operate and blood flow stagnates.
Sleep apnea is especially dangerous. Each night, as the airway closes, oxygen saturation drops. Breathing stops for a few seconds to a few minutes, and the brain wakes and resumes breathing. This process is repeated dozens to hundreds of times through the night. Repeated hypoxia gives enormous stress to the heart and blood vessels.
The gate of H opens like this. With oxygen shortage, calcium flows excessively into the cell. Without energy, calcium cannot be controlled.
The four trigger gates open in different ways. But the result is the same.
When D (Deficiency) opens, blood calcium falls. Because intake is insufficient, or absorption does not happen, or there is no stimulus.
When I (Inflammation) opens, blood calcium consumption rises. Calcium is mobilized for the immune response, and osteoclasts are activated.
When A (Acidosis) opens, blood calcium is used for neutralization. To catch acid, alkaline calcium is drawn from the bone.
When H (Hypoxia) opens, calcium regulation collapses. Because of ATP shortage the pump stops, and calcium distribution is disturbed.
Whichever gate opens, in the end PTH is secreted. PTH sends a signal to the bone. Calcium leaves the bone. This is BCO, bone calcium outflow.
The four gates are not independent of one another either. When D opens, I tends to open in its wake. When nutrition is insufficient, immunity weakens, and when immunity weakens, one becomes vulnerable to infection, and infection causes inflammation. When I opens, A tends to accompany it. When inflammation persists, metabolic waste accumulates, and waste is acidic. When H opens, I explodes. When tissue is damaged in a hypoxic state, the inflammatory response bursts out.
This is the essence of DIAH. The four trigger gates are connected to one another, and once one opens, the others become easy to open too. And whichever gate opens, the exit is one. Calcium leaves the bone.
[Table 6-1] DIAH Trigger Summary Table
| Trigger | English | Korean | Action | Explanation |
|---|---|---|---|---|
| D | Deficiency | 결핍 | Bone calcium fills the shortfall | Shortage of calcium, vitamin D, minerals; lack of physical stimulus → replenished by calcium breakdown from bone → blood → supplied to various cells |
| I | Inflammation | 염증 | Calcium is mobilized to quell inflammation | Massive calcium consumption in the inflammatory response → replenished by calcium breakdown from bone → blood → concentrated at the site of inflammation |
| A | Acidosis | 산증 | Bone is sacrificed to neutralize acid | Alkaline calcium used to neutralize acidity (pH↓) → replenished by calcium breakdown from bone → blood → whole-body pH balance |
| H | Hypoxia | 저산소 | With oxygen shortage, calcium flows excessively into the cell | Cellular oxygen shortage → Ca²⁺ pump function declines with reduced ATP → intracellular calcium overload → tissue damage |
5. The Whole Flow of the DIAH Funnel
Now let us draw the whole structure of the DIAH four-gate funnel.
At the very top are the factors. Stress, anxiety, depression, trauma. Lack of exercise, overeating, unbalanced eating, smoking, drinking. Falls, fractures, infection, surgery. Tens of thousands of factors form the wide entrance of the DIAH funnel.
These factors are divided into three tiers. The primary factors are problems of the mind and rhythm. The secondary factors are problems of habit. The tertiary factors are acute events. I will explain in detail later.
The factors flow into the four gates called DIAH. Stress connects to I-ST (stress-induced inflammation), lack of exercise to D-PH (deficiency of physical stimulus) and H-CR (circulatory hypoxia), and overeating to I-MT (metabolic inflammation) and A-DT (dietary acid load).
The factors that pass through the gates converge into one exit called BCO (Bone Calcium Outflow). No matter how varied the entrance, in the end they gather at the same exit.
After bone calcium outflow, calcium mislocation occurs. The calcium that came out of the bone travels through the blood and then piles up in the wrong places. Microvascular walls, joints, kidneys, brain. Calcium piles up in places it should not go.
Finally, 7M, the seven mechanistic results, appear. 1M Obstruction & Rupture is the change of blocking and bursting, 2M Dysfunction is the change in which function slows and drops, and 3M Coating & Blocking is the change in which signals are covered and blocked so that transmission is cut off.
Next, 4M Hardening is the change in which tissue stiffens and loses elasticity, 5M Overflow & Burst is the change in which calcium overload compounds and overgrowth and swelling appear, 6M Disconnection is the change in which the connection of nerves, blood vessels, and tissues is severed, and 7M Collapse is summarized as the change in which hard tissues such as bone and teeth fall apart.
[Diagram 6-1] The Whole Structure of the DIAH Four-Gate Funnel
| Tier | Components | Contents |
|---|---|---|
| Sea of factors | Primary factors (mind/rhythm) | Stress, anxiety/depression, sleep disorder, isolation/trauma |
| Sea of factors | Secondary factors (habit) | Lack of exercise, overeating/unbalanced eating, smoking/drinking, sedentary living |
| Sea of factors | Tertiary factors (acute events) | Falls/fractures, infection, surgery/hospitalization, accident/hemorrhage |
| DIAH four gates | D (Deficiency), I (Inflammation), A (Acidosis), H (Hypoxia) | Converge into 4 gates |
| BCO | Bone calcium outflow | Single exit |
| MILC | Calcium mislocation | Vessel walls, joints, kidneys, valves |
| 7M mechanistic results | 1M Obstruction & Rupture (blocking), 2M Dysfunction (decline), 3M Coating & Blocking (blockade), 4M Hardening (stiffening) | Pathological manifestation |
| 7M mechanistic results | 5M Overflow & Burst (overgrowth), 6M Disconnection (severing), 7M Collapse (falling apart) |
6. Why the "DIAH Funnel"
Why of all things use the metaphor of the "DIAH funnel"? There are three reasons.
First, at the entrance there are tens of thousands of factors.
Open a medical textbook. What are the risk factors for hypertension? Family history, obesity, high-salt diet, lack of exercise, smoking, heavy drinking, stress, age. What are the risk factors for diabetes? Family history, obesity, lack of exercise, high-sugar diet, stress, age. What are the risk factors for osteoporosis? Family history, low body weight, calcium deficiency, vitamin D deficiency, lack of exercise, smoking, heavy drinking, steroid use, menopause, age.
If you list the risk factors, there is no end to them. And many of the factors overlap. The risk factors for hypertension and the risk factors for diabetes and the risk factors for osteoporosis overlap to a considerable extent. Why is that? Because they enter the same DIAH four-gate funnel.
Second, the middle gates are 4.
Tens of thousands of factors in the end gather at four gates: D (Deficiency), I (Inflammation), A (Acidosis), H (Hypoxia).
When stress comes in, where does it go? Cortisol rises, and cortisol induces inflammation, and inflammation opens the gate of I. I-ST, stress-induced inflammation.
When lack of exercise comes in, where does it go? Stimulus to the bone disappears, and this opens the gate of D. D-PH, deficiency of physical stimulus. At the same time the muscle pump does not operate, so blood flow stagnates, and this opens the gate of H. H-CR, circulatory hypoxia.
When overeating comes in, where does it go? Blood sugar rises and insulin resistance develops, and this opens the gate of I. I-MT, metabolic inflammation. At the same time acidic metabolites accumulate, and this opens the gate of A. A-DT, dietary acid load.
No matter how varied the factors, in the end they pass through one of these four gates.
Third, the exit is 1.
The factors that pass through the four gates all produce the same result. PTH is secreted, and calcium leaves the bone.
Whether the entrance was stress or overeating or a fall, as time passes they converge to the same exit.
Just as all roads lead to Rome, all chronic diseases lead to bone calcium outflow. Wherever you enter, you come out at the same place.
This explains why diabetes comes to a hypertension patient, osteoporosis comes to a diabetes patient, and angina comes to an osteoporosis patient. Because they are passing through the same DIAH four gates.
Your Story: People Sucked into the DIAH Funnel
Before continuing the theory, let us first listen to the stories of two people. These stories show how the DIAH funnel actually works.
They show how the abstract D (Deficiency), I (Inflammation), A (Acidosis), H (Hypoxia) appear in real life, and how they connect.
1. Scene: The Woman in Her 70s Whose "Lying Down" Grew Long After a Fall
Ms. Jeong, a seventy-two-year-old woman, had lived healthily all her life. Her pride was that she had lived without any particular illness and without a single pill. She cared for her grandchildren, took a walk in the park every morning, and did volunteer work at church.
It was the dawn of a certain winter day. She got up to go to the bathroom, but the floor was slippery. In an instant she lost her balance and hit the floor with her hip first. The pain was severe. She could not move.
They called an ambulance. At the hospital they took an X-ray. It was a hip fracture. The neck of the femur, that is, the neck part where the thighbone connects to the pelvis, had broken. Surgery was needed.
The surgery was successful. They inserted an artificial joint, and the medical team said the progress was good. The problem was what came next.
After surgery the pain was severe. When she moved, it hurt. Ms. Jeong was afraid to move. She was afraid she might fall again, afraid it might hurt again. So she stayed lying down.
A week passed. The physical therapist came and told her to try walking. But there was no strength in her legs. The legs that only a week before had walked in the park could no longer support her body.
Two weeks passed. The leg muscles had noticeably shrunk. Her thighs had grown thin. Even when she tried to stand, her knees trembled.
A month passed. Ms. Jeong still spent most of her time in bed. Walking was frightening. What if she fell again while walking. That fear bound her legs.
Three months passed. Ms. Jeong was discharged, but she was not the Ms. Jeong of before. A walk in the park was out of the question. Even inside the house she could not walk without a cane. Caring for her grandchildren was unimaginable.
Six months passed. At a regular checkup she had a bone-density test. Her osteoporosis had worsened. Her bone density had fallen far lower than before the fracture. The doctor shook his head. "You must move. If you only lie down, the bones grow weaker."
But Ms. Jeong was already afraid to walk. She was afraid she might fall. The bones had weakened so she was more likely to fall, and because she was afraid of falling she did not walk, and because she did not walk the bones grew weaker. It was a vicious cycle.
A year passed. Ms. Jeong fell again. This time it was the spine. It was a compression fracture. Again the hospital, again the bed, again lying down.
If you read this through the DIAH pathway system, it is like this.
The start was the fall. A tertiary factor, an acute event. The fall itself may have been misfortune. The floor was slippery, it was dawn so it was dark, and with age her reflexes were not what they used to be.
But the problem was not the fall. The problem was what happened after the fall.
Being bedridden, that is, the state of lying down, opened D-PH (deficiency of physical stimulus). Bone is maintained by receiving pressure. When you stand, your body weight loads onto the bone, and when you walk, impact is transmitted to the bone. This stimulus sends a signal to the bone. "There is stimulus, so maintain the bone." But when you lie down, this signal is cut off. Without a signal, there is no reason to maintain the bone. Osteoclasts are activated, and the bone begins to dissolve.
At the same time, being bedridden also opened H-CR (circulatory hypoxia). The leg muscles play the role of a pump that returns blood to the heart. When the calf muscles contract, venous blood is pushed upward. This is called the muscle pump. When you lie down, the muscle pump does not operate. Blood flow stagnates. Blood pools in the lower limbs, and oxygen supply to the peripheral tissues decreases.
D-PH and H-CR opened at the same time. The two gates opened all at once. The speed at which calcium left the bone doubled. The fracture was not the real danger. "Lying down" was the real danger.
There is research showing that the mortality rate within one year of a hip fracture reaches 20 to 30%. It is not the fracture itself that kills a person. It is the immobility caused by the fracture that kills a person. When you lie down, you easily get pneumonia. Blood clots easily form. Muscle is lost and bones weaken. All of this combines to threaten life.
The lesson Ms. Jeong's story gives is clear. Not falling is important, but what you do after falling is more important. You must stand up quickly. Even if it hurts, even if you are afraid, you must move. Lying down is the most dangerous.
2. Scene: The Man in His 50s Whose Rhythm Collapsed from Sleep Apnea
Mr. Park, a fifty-three-year-old man, snored heavily. He had been married for 25 years, but to the point where his wife could not sleep in the same room. At first she slept in the next room. Later she slept on an entirely different floor. Even so, she said she could still hear the snoring.
Mr. Park himself thought he slept well. Because he fell asleep the moment he lay down, and it was all over when he woke up in the morning. He knew his snoring was heavy, but he thought it did not interfere with his sleep.
The problem was the daytime. During the day he was tired. After lunch he grew drowsy. In meetings his eyes closed. When driving, drowsiness came. A few times there were truly dangerous moments. There were times he closed his eyes in front of a traffic light and woke to the horn of the car behind.
Why am I so tired. Mr. Park thought it was because he was lazy, because he had grown older. So he drank more coffee. Five cups, six cups a day. Even so, he was drowsy.
Because he was tired he could not bring himself to exercise. In the past he had gone hiking every weekend, but now on weekends he lay on the sofa and watched TV. He hated to move. His body felt as heavy as a thousand pounds.
Because he did not exercise, he gained weight. 3kg in a year, 5kg in two years. His belly grew. Flesh gathered around his neck too.
Because he gained weight, the snoring grew worse. His wife said, "These days it is not even snoring, it is like your breathing stops. It is frightening." When she listened to Mr. Park's breathing at night, he would snore, then suddenly go quiet, then after a while gasp "puha!" and catch his breath, then start snoring again. This pattern repeated.
At his wife's urging he went to the hospital. He had a polysomnography test. The result was severe sleep apnea. The number of apnea and hypopnea events per hour exceeded 40. That means his breathing stopped or weakened more than 300 times through the night. At the lowest, his oxygen saturation dropped into the 70s percent. Normal is 95% or above, and the 70s percent is the level of altitude sickness.
The doctor said, "Every night you are sleeping at Everest Base Camp. That is why you are tired during the day."
That was not all. At his health checkup, hypertension was discovered. His systolic blood pressure exceeded 150. He also had an arrhythmia. It was atrial fibrillation. His heart was beating irregularly.
Mr. Park was surprised. Snoring affects the heart?
It does. When you have sleep apnea, this happens every night. The airway closes. Even when you try to breathe, air does not come in. Oxygen saturation drops. The brain senses danger. The sympathetic nervous system becomes overactive. Adrenaline is secreted. The heart beats fast. Blood pressure rises. Then the brain wakes and opens the airway. You gasp for breath. Oxygen comes in again. You fall asleep again. And then it closes again. This cycle repeats dozens, hundreds of times through the night.
This is the same as undergoing a stress test every night. The heart and blood vessels are harassed all night long. If you live like this for a few years, a few decades, the heart and blood vessels break down.
If you read this through the DIAH code, it is like this.
The start was sleep apnea. A primary factor, a problem of rhythm. Sleep apnea opened H-RS (respiratory hypoxia). Each night, as the airway closes, oxygen saturation drops, and the tissues cannot receive oxygen.
At the same time, sleep apnea also opened I-ST (stress-induced inflammation). The repeated hypoxia and re-oxygenation cause oxidative stress. In the process of tissue being damaged and repaired, inflammation arises. Each night the sympathetic nervous system becomes overactive and cortisol rises. Chronically elevated cortisol creates an inflammatory environment.
H-RS and I-ST opened at the same time. The two gates opened all at once.
But it did not end there. The fatigue caused by sleep apnea triggered a secondary factor. Because he was tired he did not exercise. Because he did not exercise, D-PH (deficiency of physical stimulus) additionally opened. Because he did not exercise, he gained weight. Because he gained weight, I-MT (metabolic inflammation) additionally opened.
Snoring was attacking the heart. And it was attacking through several routes at the same time.
3. What These Scenes Tell Us
A common point can be seen in the two scenes.
First, the name of the disease is not the problem. The pathway is the problem.
Second, it is important to know where I started.
Ms. Jeong's start was the fall (tertiary). But the real problem was being bedridden (D-PH + H-CR). She may not have been able to prevent the fall. But she could have prevented being bedridden. She had only to stand up quickly. Even if it hurt, even if she was afraid, she had only to move.
Mr. Park's start was sleep apnea (primary). He treated the snoring as trivial. But sleep apnea was opening H-RS and I-ST. If he had treated the sleep apnea, he could have stopped the chain reaction.
You must know where you started. You must know which gate opened first. Only then can you know where to block.
The Entrance of the DIAH Funnel: Three Tiers
The factors that come into the entrance of the DIAH funnel are tens of thousands. But listing them at random is meaningless. This is because the same factor has a different character depending on "where it started."
We divide these into three tiers: primary, secondary, and tertiary. This division is not a mere classification. It is the starting point of a treatment strategy.
