This piece continues from the preceding part of Stones in the Body: More Frightening Than Cancer (Yoon Jong-won). The body, figures, and citations follow the manuscript as written.
5. Why the Primary Factor Is the Deepest Root
Let me summarize.
The primary factors are invisible to the eye. They are not caught by tests. That is why they are easy to ignore.
But when the primary collapses, the secondary collapses automatically.
When you are stressed, you have no motivation to exercise. When you are depressed, you have no motivation to eat good food. When you cannot sleep, you are tired the next day and do not want to move. When you are lonely, you feel no reason to take care of your health.
Secondary correction, that is, "exercise," "eat well," "quit smoking," is possible only when the primary has recovered. Demanding behavioral change from a person whose mind has collapsed has no effect. They cannot even begin, or even if they begin they cannot keep it up.
The treatment strategy must begin with the primary. Restoring the mind and the rhythm comes first. Only then does secondary correction become possible. Only when the secondary is corrected does a reserve capacity against the tertiary arise.
The primary must not be ignored. The primary is the beginning of the DIAH funnel.
| Primary factor | Main trigger | DIAH code | Mechanism summary |
|---|---|---|---|
| Chronic stress | I (inflammation) | I-ST | HPA axis overactivation → chronic rise in cortisol → osteoblast suppression + osteoclast prolongation + chronic inflammation |
| Anxiety | D (deficiency) + I (inflammation) | D-LF + I-ST | autonomic imbalance → rise in cortisol + decrease in activity |
| Depression | D (deficiency) + I (inflammation) | D-LF + I-ST | drop in serotonin + decrease in activity + worsening eating habits + social withdrawal |
| Sleep rhythm collapse | I (inflammation) | I-ST-1 (main) + H-OT-1 (conditional) | growth hormone↓ + melatonin↓ + collapse of cortisol rhythm |
| Sleep apnea | H (hypoxia) + I (inflammation) | H-RS + I-ST | repeated nocturnal hypoxia + sympathetic hyperactivity → oxidative stress + chronic inflammation |
| Social isolation | D (deficiency) + I (inflammation) | D-LF + I-AG | deficiency of life input + rise in inflammatory markers + immune decline |
| Trauma | I (inflammation) | I-ST | chronic HPA axis hyperactivity → sustained rise in cortisol |
• Sleep rhythm collapse: centered on H-RS → I-ST (H applied only when actual hypoxia is confirmed)
Secondary Factors: Habits Widen the DIAH Funnel
Let us follow a day of Mr. Lee, a forty-eight-year-old office worker.
7 a.m. The alarm goes off. He is tired. He worked overtime last night and went to bed at 1 a.m. Just five more minutes, ten more minutes. In the end he gets up at 7:30. There is no time to eat breakfast. At a convenience store he buys one triangle kimbap and a can of coffee. It is sweet coffee with sugar. He eats it in the car on the way to work.
9 o'clock. He arrives at the company. He sits at his desk. He turns on the computer. He works sitting down.
12 o'clock. It is lunchtime. He goes to a restaurant near the company. Today it is jjamppong. The broth is spicy and delicious. He drinks even the broth to the last drop. Sodium 3,000mg. He takes in 1.5 times the daily recommended amount in a single lunch. For dessert an iced Americano. He returns to his desk again. He works sitting down.
3 o'clock. He is sleepy. He is always sleepy after lunch. He gets a chocolate bar from the vending machine. It is a sugar recharge. For a moment his mind seems to clear. Thirty minutes later he is sleepy again.
7 o'clock. It is time to leave work. Today it ended early. He meant to go to the gym, but he is tired. I will go tomorrow. He goes home.
8 o'clock. He eats dinner. He opens a delivery app. He orders fried chicken and beer. It is chimaek. He eats while watching a drama. Half a chicken, two cans of beer.
11 o'clock. The drama is fun. Just one more episode. In the end he sleeps at 1 a.m.
What do you see in Mr. Lee's day?
Sugar coffee (high sugar)
Lunch: jjamppong broth (high salt)
Snack: chocolate (high sugar)
Dinner: fried chicken (high fat, ultra-processed) + beer (alcohol)
Sleep: 6 hours (insufficient)
Exercise: 0 minutes Sitting time: 10 hours or more
This is a secondary factor. Eating fried chicken for one day yesterday does not make you sick today. Sleeping six hours for one day yesterday does not make you collapse today. But when this piles up over 1 year, 5 years, 10 years, it becomes different.
Ten years later, at a health checkup, Mr. Lee was diagnosed with hypertension, prediabetes, and fatty liver. The doctor said, "You need to change your lifestyle." Mr. Lee nodded, but inside he was puzzled. I have not done anything especially bad. I do not drink every day, I do not smoke, and I do not overeat.
But the problem was not "bad deeds." The problem was "the daily choices." Small choices that seem like nothing day by day had piled up over 10 years.
The secondary factors are drops of water. One drop is nothing. But if it falls on the same spot for 10 years, it bores a hole in the rock.
We divide the secondary factors into three baskets. Movement, food, and breathing and rhythm.
[Table] The Three Great Domains of the Secondary Factors
| Domain | Core principle |
|---|---|
| ① Movement | If you do not move, the bone dies too and the blood does not circulate |
| ② Food | If you eat wrong, inflammation flares up and acid piles up |
| ③ Breathing and rhythm | If breath and sleep collapse, oxygen is cut off |
The Movement Domain: If You Do Not Move, Two Things Collapse at Once
Lack of exercise occupies a special position in the DIAH-7M system. This is because it is the only factor that opens two gates at once. No other factor does this. This is why exercise is special.
The Double Blow of Lack of Exercise
The first blow is D-PH (deficiency of physical stimulation). It is the cutting off of the bone signal.
Bone is a living tissue. It is not a dead lump of calcium. Inside bone there are cells, there are blood vessels, and there are nerves. Bone is constantly broken down and made again. Osteoclasts dissolve old bone, and osteoblasts make new bone. This balance determines the health of the bone.
But bone is maintained only when it is stimulated. The nineteenth-century German surgeon Julius Wolff discovered this. It is Wolff's Law. Bone changes its structure according to the force applied to it. A region that receives a lot of force becomes strong, and a region that receives no force becomes weak.
Think of a tennis player's arm. The bone of the arm that holds the racket is thicker and stronger than the other arm. They are both arms of the same person, so why are they different? It is the difference in stimulation. Every time the racket is swung, a shock is applied to the bone, and that shock makes the bone strong.
Why is that? When pressure is applied to bone, the piezoelectric effect (Piezoelectricity) occurs. As the collagen fibers of the bone are compressed, a minute electric current is generated. This current sends a signal to the osteoblasts. "There is stimulation, so make bone." The osteoblasts are activated, and the bone is maintained and strengthened.
But when you do not move, this signal is cut off. Since there is no stimulation, there is no reason to maintain bone. The osteoblasts rest, and only the osteoclasts work. The bone begins to dissolve.
The evidence came from space. Astronauts live in a zero-gravity environment. In zero gravity there is no weight-bearing load on the bone. No matter how much they exercise in space, without gravity no real stimulation is applied to the bone.
According to NASA research, when an astronaut spends 6 months on the International Space Station, bone density decreases by 10-20%. It is 10-20%. It is losing in just 6 months the amount that a postmenopausal woman on Earth loses over 10 years.
It is the same on Earth. According to research by the LeBlanc team, in a state of bed rest, bone density decreases by about 1% per week. It is 1% in just one week. That is 4% in a month, 12% in three months. This is what Mr. Jeong experienced earlier. He fell and lay down, and his bones became even weaker.
The second blow is H-CR (circulatory hypoxia). It is the blood not circulating.
The heart is a pump. It pushes blood out into the arteries. Arterial blood carries oxygen and delivers it throughout the body. The blood that has set down its oxygen returns to the heart through the veins.
The problem is the veins of the lower limbs. The legs are the farthest place from the heart. And they are below the heart. For venous blood to return to the heart, it must climb upward against gravity. The pumping of the heart alone is not enough.
This is where the muscle pump comes into play. This is why the calf muscle is called "the second heart."
Think of when you walk. When you lift your foot, the calf muscle contracts. When the calf muscle contracts, the vein passing through it is compressed. From the compressed vein, blood is pushed upward. The veins have valves, so the blood cannot flow back downward. When you set your foot down, the calf muscle relaxes. As the vein widens again, blood fills in from below. At the next step, another contraction, another push upward.
With every step, pumping occurs. Just by walking, the blood of the legs returns to the heart.
But what happens if you do not move? The muscle pump does not work. Blood flow stagnates. Blood pools in the lower limbs. This is why your legs swell on the subway on the way home from work. You sat all day, so the blood pooled in your legs.
When blood stagnates, oxygen delivery decreases. Oxygen must come out of the arteries and carbon dioxide must go into the veins, but when the veins do not circulate, the entire circulation slows down. The oxygen supply to peripheral tissues decreases. This is H-CR (circulatory hypoxia).
[Figure 6-3] The Double Path of Lack of Exercise (signature figure)
| Path | Path ① D-PH (deficiency of physical stimulation) | Path ② H-CR (circulatory hypoxia) |
|---|---|---|
| Cause | lack of exercise (not moving) | lack of exercise (not moving) |
| Stage 1 | no pressure on bone | muscle pump stops |
| Stage 2 | piezoelectric signal cut off | blood flow stagnates |
| Stage 3 | osteoblast suppression, osteoclast activation | peripheral oxygen↓, tissue hypoxia |
| Result | bone calcium efflux (BCO) | bone calcium efflux (BCO) |
Lack of exercise cuts off the bone signal (D-PH) and at the same time halts the oxygen delivery of the whole body (H-CR). It is a double blow. No other secondary factor does this.
Thought of in reverse, exercise is the only intervention that blocks two gates at once. Just by walking, stimulation reaches the bone and the muscle pump runs. It blocks D-PH and it blocks H-CR too. It is closing two doors with a single action.
The Sedentary Life: Why Exercising Is Not Enough
"But I do exercise."
There are people who say this. They go to the gym three times a week. They exercise hard for an hour each time. But their health checkup results do not improve. Why is that?
It may be because of the sedentary life.
The sedentary life is different from lack of exercise. It is a subtle but decisive difference.
Lack of exercise is not doing intentional exercise. Not going to the gym. Not jogging. Not swimming.
The sedentary life is that the amount of daily activity itself is small. Sitting all day long.
Let us do the math. A day is 24 hours. Subtracting 7 hours of sleep leaves 17 hours. Of these, the time spent exercising at the gym is 1 hour. What do you do for the remaining 16 hours?
You sit in the car on the way to work. You sit and work at the company. You walk only briefly when you go to eat lunch. After lunch you sit and work. You sit in the car on the way home. You come home and sit on the sofa and watch TV.
One hour of exercise, 15 hours of sitting. Can 1 hour beat 15 hours?
A meta-analysis by the Ekelund team answered this question. It is the result of analyzing data from more than 1 million people. If you sit for 8 hours or more a day, even 1 hour of exercise a day did not completely offset the health risk.
Even if you exercise hard for 1 hour, if you spend the rest of the time sitting, it is still dangerous. You did exercise, but the harm of the sedentary life remains.
Why is that? Because sitting itself affects metabolism.
When you sit, the large muscles are deactivated. The quadriceps (thighs), the gluteal muscles (buttocks). They are the largest muscles in the body. When these muscles are deactivated, the fat-dissolving enzyme (LPL, Lipoprotein Lipase) is suppressed. LPL is an enzyme that breaks down fat in the blood. When this enzyme is suppressed, fat in the blood is not broken down and piles up.
Insulin sensitivity also drops. Muscle is a major organ that absorbs glucose. When muscle is not active, glucose absorption decreases. Blood sugar rises, and insulin resistance develops.
All these changes begin within just a few hours of sitting. They are not solved by 1 hour of exercise at the gym.
What is the solution? Moving a little bit throughout the day. If you sit for 50 minutes, stand up and walk for 10 minutes. Take the stairs instead of the elevator. Take a walk, even for 10 minutes, at lunchtime. Stand up when you take a phone call.
Daily movement may be more important than exercise at the gym.
The Food Domain: What Happens at the Modern Table
Let us return to Mr. Lee's day again. This time let us focus on the food.
Morning: Triangle Kimbap + Can of Coffee
Lunch: jjamppong (broth included)
Snack: Chocolate Bar Dinner: Fried Chicken + Beer
What is the problem with this diet? All of it is a problem. Let us take it apart one by one.
High-Salt Diet: Saltiness Dissolves Bone
Jjamppong broth. It is spicy and delicious. You clean out even the broth. But how much sodium is in this one bowl of broth?
The sodium content of one bowl of jjamppong is roughly 2,500-3,500mg. The daily sodium intake recommended by the WHO is less than 2,000mg. In a single lunch you far exceed the daily recommended amount.
Koreans are among the peoples who consume the most sodium in the world. According to the National Health and Nutrition Survey, the daily average sodium intake of Korean adults is close to 4,000mg. It is twice the WHO recommendation.
Why is salty food a problem? Because sodium drags calcium out.
When sodium is excessive, it must be excreted by the kidneys. But when the kidneys excrete sodium, calcium is excreted along with it. Sodium excretion and calcium excretion are linked. There is research showing that every time you take in 2,300mg of sodium (6g of salt), about 40mg of calcium leaks out into the urine.
Saltiness is dissolving the bone.
High-Sugar Diet: Sweetness Kindles Inflammation
The sweet can of coffee drunk in the morning. The chocolate bar eaten in the afternoon. It is sugar.
Sugar quickly raises blood sugar. When blood sugar rises, insulin is secreted from the pancreas. Insulin lowers blood sugar. Up to here it is normal.
The problem is when this is repeated several times a day, every day, for years.
The cells become insensitive to insulin. It is insulin resistance. Even when insulin is secreted, blood sugar does not go down well. The pancreas secretes even more insulin. It is hyperinsulinemia. Even so, blood sugar does not go down well. Blood sugar becomes chronically high.
High blood sugar is toxic. It is called glucotoxicity.
High blood sugar binds with proteins. Advanced glycation end products (AGEs, Advanced Glycation End Products) are formed. The name is difficult, but if we compare it to cooking it is simple. When you grill meat, it turns brown. It is the Maillard reaction. Sugar and protein bind to form a brown substance.
This happens inside the body too. When blood sugar is high, sugar sticks to the proteins in the body. AGEs are formed. AGEs pile up in the tissues and induce inflammation. When they pile up on the vessel walls, arteriosclerosis; when they pile up on the skin, wrinkles; when they pile up in the eyes, cataracts.
Insulin resistance itself also induces inflammation. When there is insulin resistance, the fat tissue changes. In particular, visceral fat becomes active. Visceral fat is not a simple storehouse. Visceral fat is an endocrine organ that secretes inflammatory cytokines. It spews out inflammatory substances such as TNF-α and IL-6.
Sweetness is kindling inflammation. It is I-MT (metabolic inflammation).
Ultra-Processed Food: Inflammation Made in a Factory
Let us think about fried chicken. Fried chicken is chicken. Chicken is a natural food. But what about delivery fried chicken?
How many times has the oil used to fry the chicken been used? What is in the batter? What is in the seasoning? What is in the sauce?
When you look at the list of ingredients, unrecognizable names appear. Modified starch, acidity regulators, phosphates, monosodium glutamate, synthetic flavorings.
This is ultra-processed food (Ultra-Processed Food, UPF). It is food processed to the point where the original ingredients cannot be recognized. Ramen, snacks, sausages, frozen pizza, carbonated drinks, ice cream. They are the things that have occupied the modern table.
There are three problems with ultra-processed food.
First, the nutrient density is low. The calories are high. Because they are packed full of fat, sugar, and salt. But vitamins, minerals, and fiber are scarce. Even if you eat a lot, nutrition is lacking. Your belly is full, but your cells are starving.
Second, there are many additives. In particular, phosphates are a problem. Phosphates are used for many purposes in the food industry. Preservation, color retention, texture improvement. They are widely found in processed meat, cheese, carbonated drinks, and frozen food.
When phosphate is excessive, the calcium-phosphorus balance is broken. Phosphorus (P) and calcium (Ca) affect each other. When there is a lot of phosphorus, calcium absorption is hindered. In the intestines, calcium and phosphorus bind to become an insoluble complex and are simply excreted. Calcium that should be absorbed is excreted.
Third, it induces inflammation. There is research showing that a diet centered on ultra-processed food raises inflammatory markers. The exact mechanism is still under research, but it appears that additives, substances produced during processing, and nutritional imbalance act in combination.
Ultra-processed food opens I-MT (metabolic inflammation) + A-DT (dietary acid load) + D-NT (nutritional deficiency) at the same time. Three codes open all at once.
Drinking: What Alcohol Does to Bone
Mr. Lee's dinner, the two cans of beer drunk along with the fried chicken. Not every day, but three or four times a week. He thinks, "I am not someone who drinks a lot." But this piles up too.
Let us follow how alcohol is processed in the body.
Alcohol arrives at the liver. In the liver, alcohol dehydrogenase (ADH) breaks down the alcohol. Acetaldehyde is formed. Acetaldehyde is a toxic substance. It is the cause of hangovers. The reddening of the face is also because of this.
Acetaldehyde is broken down again to become acetic acid. Acetic acid is acidic. It is broken down further into water and carbon dioxide. In this process, acidic metabolites are produced. The acid load of the body increases. It is A-DT (dietary acid load).
Alcohol induces oxidative stress. In the process of breaking down alcohol, reactive oxygen species are produced. Reactive oxygen species attack cells. Tissue is damaged. An inflammatory response occurs to repair the damaged tissue. It is I-MT (metabolic inflammation).
Alcohol hinders nutrient absorption. It irritates and damages the gastric mucosa. It lowers the absorptive capacity of the small intestine. In particular, the absorption of B vitamins, folate, zinc, and magnesium decreases. It is D-NT (nutritional deficiency).
Alcohol directly suppresses osteoblasts. The cells that make bone cannot do their work. Osteoclasts are less affected. The making side is suppressed and the dissolving side stays the same. The result is obvious.
Two cans of beer do all of this. Not every day, but three or four times a week, for 10 years.
The Breathing and Rhythm Domain: When Breath and Sleep Collapse Smoking: The Habit That Steals Oxygen
Mr. Lee does not smoke. But for readers who smoke, let me explain.
Cigarette smoke contains thousands of chemicals. Among them, the ones especially harmful to bone are carbon monoxide (CO) and nicotine.
Carbon monoxide steals oxygen. Think of hemoglobin. Hemoglobin is a protein inside red blood cells. It binds with oxygen and delivers oxygen throughout the body. But carbon monoxide binds to hemoglobin more than 200 times more strongly than oxygen.
When you smoke, carbon monoxide enters the lungs. Carbon monoxide binds with hemoglobin. That hemoglobin can no longer carry oxygen. The oxygen-carrying capacity of the blood drops. Less oxygen is delivered to the tissues. It is H-RS (respiratory hypoxia).
Nicotine constricts blood vessels. When blood vessels narrow, blood flow decreases. In particular, the microvessels are greatly affected. When the microvessels of peripheral tissues, the skin, and the bone constrict, the supply of oxygen and nutrients to those regions decreases.
The chemicals in cigarette smoke induce inflammation. The airway mucosa is irritated. Chronic bronchitis develops. It is chronic inflammation. It is I-EN (environmental amplifier).
There is much research showing that the fracture risk of smokers is higher than that of nonsmokers. There is also research showing that fracture recovery in smokers is slower. With reduced oxygen supply and persistent inflammation, it is a natural result.