Symmetry in health and illness

 Introduction

The world in which we live, and of which we are a part, is a marvelous, complex, and multidimensional system that contains everything we know, as well as countless unknowns. Its mystery remains one of the main challenges for science, especially when it comes to questions of its origin, evolution, and ultimate fate. Scientists have been seeking answers to these questions for centuries, yet a significant part of this universal mechanism remains beyond our understanding.

Symmetry is one of those fundamental regularities that permeate all aspects of the world, from the smallest atoms and their particles, which form a stable basis for matter, to galaxies and even larger cosmic structures. This principle of organization has a universal character, and interestingly, it is present not only in inorganic nature but also in all aspects of the living. Symmetry penetrates every element of the living world, starting from the simplest forms of life that border on inanimate nature (such as prions, viroids, and viruses) and ending with humans—a multifaceted organism that combines physical, physiological, mental, and social aspects.

Moreover, symmetry has become the principle of organization even in new, artificial forms created by humans, including artificial intelligence. This product of technological evolution has its unique structure and functions, and it may soon surpass the capabilities of living nature. Although artificial intelligence remains an inanimate structure, it is acquiring more and more properties reminiscent of those built on the principle of symmetry in living organisms.

Symmetry, thus, is not just a characteristic of the structure of things but a profound property that reflects the order and harmony of the world. It acts as a sort of "code" for the organization of matter, particularly evident in living organisms, where relatively small amounts of DNA are capable of containing vast arrays of information. Thanks to this "code," it becomes possible to compactly store and transmit information about the structure, functions, and life cycle of an organism, ensuring its development, adaptation, and survival in the world.

Humans, let us repeat, are currently the highest manifestation of symmetry, as their physical and physiological dimensions harmoniously combine with highly developed mental and social aspects. And what is particularly interesting, this symmetry is present not only in health but also in the processes of disease. Disease, like health, adheres to this principle, which permeates all sides of life, and as a result, allows us to uncover the deep mechanisms of the functioning of the organism.

Mastering the principle of symmetry is of exceptional importance for medicine, as understanding its laws allows not only a deeper comprehension of the nature of health and disease but also finding optimal ways of their treatment. The principle of symmetry helps to see the human as a holistic system, where each component is interconnected and interacts with each other both in health and in disease. This is the key to providing truly effective assistance that considers the multifaceted nature of human beings, which was the main motivation for writing this book.

We want to express our sincere gratitude to our scientific colleague V. Shliakhover from Israel, who found the time to review this work and provided valuable suggestions that helped improve it, and especially to V. Danovsky, the talented designer of our books.

We welcome comments and suggestions with gratitude.

M. Iabluchanskyi, A. Yabluchanskiy

Examples encourage and inspire

For a long time in both scientific and practical activities, we have relied on the principle of symmetry as a fundamental foundation for approaching the solution of many medical tasks. It is thanks to this principle that we can relatively easily find solutions where others encounter serious difficulties. The principle of symmetry acts as a kind of "compass" that allows for a more holistic assessment of the situation, understanding the interconnections between various aspects of health and disease, and building effective approaches to treatment.

Medical practice and scientific research offer numerous examples where symmetry has been the key to understanding the conditions being studied. To illustrate its significance, let us present three examples, to which or the explanation of which we have been involved.

To the question of why only three examples, we respond that there must be a time to transition from dancing around the principle to laying it out. By the way, in the exposition, there will be an opportunity to provide examples, and we will certainly take advantage of this opportunity.

Isolated hypertrophy of the temporal muscles

A doctor consulted with an unusual case because previous inquiries to colleagues did not help resolve the issue. The patient presented with markedly hypertrophied temporal muscles that were prominently visible. It was the first case of its kind in his practice, causing some surprise and a need for further explanation. For us, it was also a new experience, but a hypothesis arose easily.

We were dealing with isolated, i.e., localized hypertrophy of only the temporal muscles, without changes in other skeletal muscles of the head. Additionally, the hypertrophy was symmetrical, adding another layer to the clinical picture. This situation reminded us of hypertrophic cardiomyopathy, a well-known condition in cardiology, where excessive thickening of certain heart structures, such as the papillary muscles, the left ventricular outflow tract, etc., can occur. Hypertrophic cardiomyopathy is usually genetically determined.

Therefore, it was decided to conduct a thorough literature search for relevant keywords, particularly for "hypertrophic myopathy of the temporal muscles." The search confirmed that such a disorder does exist and is quite rare in medical practice.

As noted in the literature, isolated hypertrophy of the temporal muscles is most commonly observed in people with certain occlusal features, dysfunction of the temporomandibular joint, and in patients with habits that lead to overstraining of the masticatory muscles. For example, such habits include regular clenching of teeth (bruxism) or excessive chewing gum use. However, there is also hypertrophy of other muscle groups in such cases.

The uniqueness of our case allowed us to suspect genetically determined, or hereditary, hypertrophy of the temporal muscles. The pronounced hypertrophy with absolute symmetry of the right and left muscles, with complete integrity of other facial muscle groups, and any indications of any type of cyclic load supported such a thought. Family history provided additional levers for understanding this case.

Genetically determined isolated hypertrophic myopathy of the temporal muscles is even rarer than the acquired type, but such cases are documented. Studies indicate that genetic factors can significantly influence the predisposition to hypertrophy of the facial muscles. Similar features of muscle structure and function can be passed down from generation to generation, forming a predisposition to hypertrophy even under moderate loads. This was indeed the case here.

Familiarity with the principle of symmetry and the experience gained in applying it to solve similar medical tasks allowed us to easily establish a diagnosis, which is key to justified treatment. By the way, in this case, we encounter an example of translational symmetry—transferring the nature of hypertrophic cardiomyopathy to the nature of hypertrophic myopathy of skeletal muscles.

Shortened QT interval on electrocardiogram

At the IX National Congress of Cardiologists of Ukraine in 2008, I. Gussak from the USA delivered a lecture on syndromes of prolonged and shortened QT. The prolonged QT syndrome is well-known within the cardiological community: its presence indicates a high risk of developing lethal arrhythmias. This condition can be both congenital and acquired. One of the causes of acquired prolonged QT is the effect of medications that can extend the QT interval on an ECG. This is why each new drug undergoes rigorous testing for its potential impact on QT before it is released to the market.

Interestingly, the honor of discovering the shortened QT syndrome belongs to I. Gussak, and the circumstances of this discovery deserve special attention. In the 1980s, I. Gussak was working at the Kaunas Center for Arrhythmias. Engineers working on the development of "intelligent" pacemakers asked him to create a list of ECG signs that could signal life-threatening conditions. Among other signs, I. Gussak noted prolonged QT. An engineer asked him if there was also a syndrome of shortened QT, to which I. Gussak jokingly replied that such questions required a medical education and at least 20 years of medical experience.

Later, these words made him reflect: the idea of the existence of shortened QT turned out to be justified, and this issue did not give him peace. Reflecting on it, he realized that the engineer's question was logical and possibly subconsciously based on the principle of symmetry, which admits the possibility of the existence of a mirror deviation from the norm. If prolonged QT is dangerous, then the existence of shortened QT, which could also pose a certain threat, is quite plausible.

I. Gussak found the first cases of shortened QT, but it was only after emigrating to the USA and supplementing his observations with new data that he prepared an article, which he sent to one of the cardiological journals for publication. However, the path to publication was not easy: the editorial initially refused to accept the article, considering it a falsification. Only after providing additional evidence, such as specific ECG recordings, was the article approved for publication. This process took over 10 years from the discovery of the syndrome to its recognition by the scientific community.

The engineer's intuitive question about the possibility of the existence of shortened QT was based on the concept of symmetry, although it was not obvious at the time. If prolonged QT syndrome is dangerous, then the principle of symmetry suggests that its "mirror" deviation—shortened QT—could also pose a threat. However, among medical specialists at that time, there were not enough who were familiar with the principle of symmetry to notice this connection.

After some time, I. Gussak had another idea—the possibility of the existence of shortened QRS syndrome. This intuitive search also proved successful: he managed to find cases of this condition. Here the principle of translational symmetry worked: shortened QRS was predictably existent, but it required knowledge of the principle of symmetry and its application in medical practice.

These two examples demonstrate that knowledge and understanding of the principle of symmetry could have allowed the author to make his discoveries much earlier. Considering the clinical significance of both syndromes due to their potential danger to human health, timely discovery and dissemination of this knowledge could have facilitated faster diagnosis and prevention of dangerous clinical manifestations in medical practice.

Increased heart rate variability

Heart rate variability (HRV) is one of the innovative technologies that, after a long period of scientific research, found successful application in the space industry, particularly for monitoring the health of astronauts during extended missions. Thanks to its ability to detect early signs of stress, fatigue, and other potential problems, HRV has become an important element of the astronaut monitoring system. Today, after its effectiveness has been confirmed, it is actively being implemented in general medical practice, where it helps monitor the condition of patients with various diseases, primarily cardiovascular, as well as to assess stress levels and overall health.

We have also joined in studying and practically applying this promising technology. During the analysis of patient assessment protocols, we noticed that traditional criteria for deterioration are usually focused only on a decrease in heart rate variability indicators, which often results from predominant activity of the sympathetic nervous system over the parasympathetic. However, our knowledge of the principle of symmetry led us to hypothesize that an increase in variability could also be a symmetrical indicator that might signal negative changes in health status.

We hypothesized that a significant increase in HRV indicators, associated with the dominance of the parasympathetic link over the sympathetic, could indicate the other side of the imbalance. This condition is often observed when sympathetic activity is suppressed, which may indicate disruptions in adaptive processes in the body, especially in cases of chronic fatigue, cardiovascular system dysfunction, or reduced stress resilience.

The results of our study confirmed this hypothesis: both a decrease and a significant increase in heart rate variability indicators can indicate disorders in the body that require attention. This discovery has become an important tool for improved patient monitoring in clinical practice, helping not only to detect the risk of developing complications but also to maintain the overall balance of the sympathetic and parasympathetic systems.

Thus, this example underscores the significance of the principle of symmetry as a universal tool that allows health parameters to be considered from both sides: not only from the perspective of reduction but also of increase. The application of this principle in scientific and practical medicine expands the possibilities for early diagnosis and allows for the individualization of treatment approaches, enhancing the accuracy of patient condition assessment and providing the opportunity to respond timely to potential changes in health status.

Remarks on examples

The examples presented vividly demonstrate that mastery of the principle of symmetry is not just a theoretical approach but a powerful tool for achieving more accurate scientific results and higher quality in clinical diagnosis of diseases. Applying this principle allows us not only to better understand the nature of health and disease but also to accurately monitor the progression of diseases at different stages of treatment, ensuring timely adjustment of therapy and achieving optimal outcomes.

Some may consider the examples provided sufficient to illustrate the value of symmetry in medical science and practice. However, it must be emphasized that these are just individual aspects that reflect part of the wide range of opportunities opened by the principle of symmetry. Symmetry is multifaceted and multi-leveled: its manifestations go far beyond these examples. Mastery of this principle, especially in the conditions of modern medical practice, is extremely important for those who aspire to become highly qualified scientists or professional doctors capable of understanding the processes occurring in the human body in all their complexity.

Moreover, as we have already mentioned in the introduction, symmetry is a fundamental principle that manifests in all aspects of human life—both in health and in disease. It encompasses physical, functional, mental, and social dimensions, forming a complex yet harmonious system. The principle of symmetry is even present in therapeutic approaches used in medical practice, including the selection and mechanism of action of medications, methods of treatment and rehabilitation, as well as principles of health maintenance and prevention.

Therefore, we must not only consider these examples but also continue to study this principle more deeply, as it is key to achieving a holistic approach to medicine that allows us to view a person in a complex manner, taking into account all aspects of their existence and interconnections.

You can learn more by reading our e-book or listening to our audiobook 

Andriy Yabluchanskiy  together with Mykola Iabluchanskyi