Integrative Medicine: An Overview

Transcription

1 Integrative Medicine: An Overview Allan Sosin, MD Institute for Progressive Medicine (949)

2 Dangers In Medicine 100 thousand people die yearly from side effects from medications Pharmaceuticals cost $200 billion per year Medical Expenses in the US cost upwards of $2 trillion per year. 20,000 die yearly from medical errors The more drugs you take, the greater the risk of complications, the effect increases with age

3 What is Alternative Medicine? Alternative Medicine implies disagreement or rebellion - a group in opposition to conventional practices In some circles, traditional therapies such as drugs, surgery or vaccination are viewed as a violation of human integrity

4 What is Integrative Medicine? Integrate means to make whole by bringing together additional parts Integrative Medicine seeks to coordinate proven traditional medicine with safe and effective alternative therapies In an integrative practice we do use traditional therapies when indicated Prescription Drugs Surgery Referrals to Specialists

5 What We Believe Many diseases are preventable or reversible Many diagnoses are not permanent Many drugs cause complications that lessen the quality of life Surgery is performed in excess Exercise and Nutrition are vital elements in promoting good health

6 What We Do Help people get off harmful or unnecessary drugs Help people avoid unnecessary surgeries Use nutrition as a major technique for maintaining and improving health Recommend nutritional supplements Use herbal therapies Offer natural hormone replacement therapies and other compounded prescriptions Help people modify stress factors that contribute to disease

7 What We Do We Can Prevent or Reverse: Heart Disease Diabetes Hypertension Osteoporosis Gastrointestinal Disorders Obesity Chronic Fatigue Inflammatory Conditions Autoimmune Disease

8 What We Do Assist the patient in finding the most appropriate therapies Help reduce side effects from chemotherapy and radiation Improve and prolong life

9 Diabetes: Definition Blood sugar over 126 fasting Blood sugar over 200 at any time HgB A1C at 7% or more

10 Diabetes: Causes Adult onset diabetes is a problem caused by insulin resistance often due to: Poor food choices Overweight Nutrient Deficiencies Lack of Physical Activity

11 Prediabetes Hg A1C over 5.0 and less than million people are affected in the US The major risk factor for heart disease and stroke Treatment is the same as for diabetes Get tested!

12 Poor Diet BOOK - Fast Food Nation By: Eric Schlosser MOVIE Supersize Me By: Morgan Spurlock

13 Diet for Diabetes Low Glycemic Index foods Three meals a day and snacks High fiber Low caloric density Avoid starchy foods Avoid Soft drinks, refined grains, sugars Be VERY careful in restaurants- they add sugar and salt

14 Glycemic Index Glycemic index is a measure of how much a 50 gram carbohydrate portion of a food will raise the blood sugar. HIGH Sugar White bread Cheerios Banana French fries LOW Cabbage Blueberries Lentils Soybeans Almonds

15 High Dietary Fiber Lowers Blood Sugar The average American gets about 12 g of fiber daily. Recommended daily fiber intake- 25g But- 50 g of fiber daily lowered the fasting blood sugar 13 mg Lower insulin secretion Beneficial Effects of High Dietary Fiber Intake in Patients with Type 2 Diabetes Mellitus, NEJM 2000: 342;

16 Benefits of Fiber 1. Provides mass without calories (low caloric density-a a stalk of celery contains only 6 calories.) 2. Slows absorption of foods so blood sugar doesn t go so high 3. Reduces the need for insulin release to bring the sugar back down again 4. Reduces the absorption of cholesterol from foods 5. Foods containing fiber also contain phytonutrients and antioxidants

17 Culprits: Fast Foods and Soft Drinks Sugar-sweetened soft drinks contribute 7.1% of total energy intake and represent the largest single food source of calories in the U.S. diet. Women who increased soft drink intake from 1 or less per week to 1 or more per day gained 8 kg over 8 years, compared with 2.8 kg in women who maintained less than 1 drink per week.* *JAMA, August 25, 2004, pp

18 and diabetes goes up Relative risk of diabetes 1.83 in women consuming 1 or more soft drinks per day, compared with less than 1 drink per month. *JAMA, August 25, 2004, pp *JAMA, August 25, 2004, pp

19 Supplements for Diabetes B Vitamins Biotin folic acid B6 B12 Fish Oil Minerals Magnesium Chromium Vanadium Gymnema sylvestre Green Tea

20 About Exercise Exercise Goal: minutes, 7 days a week This amount of walking will burn up 2000 calories In the Nurses Health Study, this level of activity reduced the risk of heart disease in diabetic women by 35%* *Physical Activity and Risk for Cardiovascular Events in Diabetic Women, Ann Intern Med 2001; 134:

21 About Exercise Walking Rebounding Dancing Bicycling Jogging Swimming Yoga Tennis Golf Etc

22 Hypertension and Obesity Use the same program!

23 Walking Wounded: Case Study 44 year old lawyer with fatigue Highly Stressed Overweight No Exercise Short of Breath Heart Races Frequently Coffee = 8 cups/day Diet Soda = 3-4/day3

24 Walking Wounded: Case Study

25 Walking Wounded: Case Study High Protein Low Glycemic Index Diet No Coffee No Soda Walk 30 minutes Per day

26 Walking Wounded: Case Study BEFORE (8/05) AFTER (3/06) Cholesterol Triglycerides HDL LDL Chol/HDL CRP Weight 215 lbs. (5 6 ) 175 lbs. Symptoms Fatigue, palpitations, shortness of breath GONE!

27 About Hormones Hormones change the aging process Hormone levels affect how you feel Many hormones decline with age Cortisol levels increase with age

28 Human Growth Hormone (hgh) Works by injection only Measure IgF-1 1 to see where you are. Ideal level is 300 for IgF-1

29 Human Growth Hormone (hgh) Prevents heart failure Supports the failing heart Increases bone density Reduces abdominal fat Builds muscle Strengthens connective tissue Enhances athletic performance Improves your state of mind Makes your skin look better

30 Human Growth Hormone (hgh) 1-22 units prescribed daily Inject with thin insulin needle Inject into abdomen, subcutaneously Frequent early changes Maximum effect noted at 3 months Measure IgF-1 1 level Usually rises points Do not take hgh if you have cancer

31 Estrogen Fell into disrepute 3 years ago Concerns over breast cancer and heart attacks Studies involved Premarin and medroxyprogesterone containing carcinogenic compounds Both of these drugs are not human hormones

32 Natural, Bioidentical Estrogen Bioidentical hormones have the exact same structure as human hormones Derived from plant sources Available by prescription Can be ordered from a compounding pharmacy Avoid oral estrogen causes increased production of clotting factors in the liver.

33 What About Hormones & Cancer? 976 women studied from Ongoing therapy with subcutaneous pellets Oral progesterone for women without hysterectomy Yearly mamograms and pelvic exams *Marked Reduction of Breast, Endometrial, and Ovarian Cancer in Users of Bioidentical Estradiol and Testosterone Subcutaneous Pellets, Gino Tutera, M.D.

34 What About Hormones & Cancer? Only one case of breast cancer, node Only one case of endometrial cancer No ovarian cancer *Marked Reduction of Breast, Endometrial, and Ovarian Cancer in Users of Bioidentical Estradiol and Testosterone Subcutaneous Pellets, Gino Tutera, M.D.

35 Estrogen: Benefits Handles menopausal symptoms Hot flashes, night sweats, loss of libido Thin dry and wrinkled skin Insomnia Depression and memory loss Increases bone density Increases flexibility of arteries Future studies will again show decreased risk of heart attack and stroke

36 Estrogen: Benefits Women look younger Brains work better Does it prevent dementia?

37 Estrogen: Methods of Delivery Natural estrogen is taken in the form of estradiol Take estrogen as a: transdermal cream, sublingual drop or lozenge subcutaneous pellet Women must take progesterone if uterus is still present to protect the uterus

38 Testosterone: Benefits For All Increased athletic performance, muscle strength Increased bone density Manage migraine headaches Increased Libido (both men and women) Strengthens the heart Decreased fatigue Increased sense of well-being

39 Testosterone: Methods of Delivery Testosterone levels decrease with age Take Testosterone as a Sublingual drop or lozenge Transdermal cream Weekly injection Subcutaneous pellet Men cannot use in presence of prostate cancer unless the cancer is treated Men should follow PSA levels and blood count

40 Benefits of Hormone Pellets Estrogen and Testosterone can be administered as a subcutaneous pellet Smaller than a grain of rice Lasts months Provides continuous blood levels Eliminates daily dosing More effective in raising bone density

41 Hormones and the Heart Heart failure is the major cause of hospital admissions in older people Men of all ages with chronic heart failure had lower levels of testosterone, IgF-1, and DHEA sulfate than those without heart failure* The lower the hormone levels, the worse the heart failure* Men with heart failure who had normal hormone levels had better survival* *Anabolic Deficiency in Men with Chronic Heart Failure: Prevalence and Detrimental Impact on Survival, Circulation, (17):

42 Osteoporosis Osteoporosis is thin, weak bones (Not like this!)

43 Osteoporosis Healthy Bone Matrix Osteoporotic Bone

44 Vertebral Compression Fracture

45 Osteoporosis Diagnosed and monitored with a bone density study called a DEXA bone scan Scans of the hip and lumbar spine are performed T score of -2.5 defines osteoporosis

46 Consequences of Osteoporosis Lifetime risk of hip fracture is 1/5 in women and 1/15 in men Post fracture statistics 1/2 do not return to normal function 25% are admitted to nursing homes 20% mortality within one year

47 Osteoporosis Risk Factors Family history Small frame- under 127 pounds Years of estrogen deficiency High protein, high salt diet Lack of exercise Coffee Sugar Smoking Age

48 Osteoporosis: Supplements Calcium 1500mg/day (600mg from diet) Vitamin D 3000 I.U./day Magnesium mg/day Strontium 720mg/day Vitamin K2 Walking 30 minutes/day Green Tea

49 Osteoporosis: Medications Estrogen, progesterone Testosterone DHEA hgh-human human growth hormone injections Raloxifene (Evista )-reduces spinal fractures only, can cause blood clots IV Bisphosphonates- Zometa

50 Osteoporosis: Lifestyle Low salt, low sugar diet No Coffee or soft drinks Plenty of weight bearing exercise, walking.

51 Osteoporosis Case Study 82 y.o.. woman Severe osteoporosis Hip T score: -3.3 Lumbar spine T score: -4.5

52 Osteoporosis Case Study Fractures of 3 lumbar vertebrae Severe pain Could not ambulate Bent over Could not sleep Refused surgery, decided to get better

53 Osteoporosis Case Study Therapy: Local injections Reacted Calcium/magnesium Vitamin D Strontium Vitamin K Estrogen, testosterone, DHEA, hgh Zometa Low salt, low protein diet Walking

54 Osteoporosis Case Study One Year Later Hip bone density increased 3.4% Spine bone density increased 13.4% No pain Straight posture

55 Heart Disease: Risk Factors Cholesterol Hypertension Diabetes Homocysteine Stress, Type A Personality No Exercise Obesity Cigarettes No Alcohol No fruits or vegetables

56 Cholesterol Statin Drugs or Diet Plant Sterols Niacin Red Yeast Rice

57 Hypertension Magnesium Trace Minerals Water Potassium Herbs Low Caffeine

58 Homocysteine Homocysteine is a natural breakdown product of the amino acid methionine To lower homocysteine take: B12 Folic Acid B6 Trimethylglycine

59 Heart Disease: Testing Stress tests do not pick up early disease Coronary CT calcium score Coronary CT angiogram CV Profiler

60 Heart Disease: Treatments In patients with stable disease Percutaneous Coronary Intervention (PCI), (angioplasty or stent) ) did NOT reduce the risk of death, myocardial infarction, or stroke Do not initiate evaluation with an angiogram *Optimal medical therapy with or without PCI for stable coronary disease, NEJM, 2007;356

61 Heart Disease: EECP EECP stands for Enhanced nhanced External Counterpulsationulsation Originally approved by the FDA to treat angina pectoris (chest pain)

62 Heart Disease: EECP Increases circulation throughout the entire body Effective for heart attack, stroke, peripheral vascular disease A powerful anti-aging aging therapy

63 Heart Disease: EECP Success Story History 50 year old man with prior bypass surgery Severe heart failure Shortness of breath Swollen legs No exercise tolerance BNP 966 (normal under 100) Treatments EECP Chelation and PC CoQ10 Fish oil Magnesium D-ribose Low dose Lasix,, ACE inhibitor Low salt, vegetarian diet, plus fish

64 Outcome: Heart Disease: EECP Success Story Lost 25 lbs. Edema gone Shortness of breath gone Normal exercise tolerance BNP reduced to 90 (in normal range)

65 Supplements Vitamins, minerals and herbs are the mainstay of the lifestyle approach Quality, purity and potency are key to an effective supplement regimen Do NOT purchase poor quality supplements- avoid most major chain brands Vitamins are rarely dangerous Protect your right to have them!

66 Key Supplements A high quality multivitamin Fish Oil Calcium and Magnesium Green Drink Powder CoQ10 Alpha Lipoic Acid B Vitamins (B12, B6, Folic Acid) Others based on individual conditions

67 IV Therapy: Immune Drip An immune drip is an IV therapy with high dose vitamins and minerals Good for: infections, fatigue, pre and post operations, stress, fatigue, and cancer patients (support for chemo and radiation) Excellent for patients coming off alcohol and street drugs

68 IV Therapy: PK Protocol Developed by Patricia Kane Ph.D. IV Infusion (push) of 3 nutrients: Phosphatidyl Choline (PC) Folinic Acid Glutathione Also good for compromised liver function and liver disease

69 IV Therapy: PK Protocol Used for the following: Parkinson s Disease Multiple Sclerosis ALS Stroke Liver Disease Alzheimer s Disease Dementia Memory Loss

70 PK Protocol Case Study Patient #1 65 year old male, liver failure and hepatitis C, Sluggish, lethargic Instant clearing, perked up after 1 st treatment Patient #2 49 year old executive with memory loss Sharper after 1 st treatment

71 PK Protocol Case Study Patient #3 71 year old man with memory loss for 3 years No more problems Patient #4 75 year old woman with Parkinson s Buttoned her blouse after 1 st treatment, 1 st time in over a year!

72 Saving the Brain: Drugs Drugs that impair brain function Sedatives, tranquilizers, beta blockers, antidepressants and other psychoactive medications Psychiatric Drugs These are recklessly prescribed They are suppressants They impair memory, alertness Reduce your ability to confront and control your environment May cause suicidality

73 Saving the Brain: The Most Important Factors Communicate reach out and do not isolate yourself. Communication is the measure of life. Create Produce, produce, produce! Help Volunteer your time, energy and knowledge Move Exercise, use the body

74 Detoxification Eliminate drugs and toxins Heavy metals, preservatives, synthetic hormones, additives, colorings, cosmetics Eat organic foods Do a sauna detox program