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Are we practicing “metabolic pathway blockage” medicine or are we normalising homeostasis and metabolic harmony when managing chronic disease states?
Today we find, as practicing physicians, that we are managing a number of chronic disease states, particularly in the elderly, with an increasing amout of chronic pharmaceuticals.
There is another option…It is an integrative, science-based approach that treats illness and promotes wellness by looking at the biochemically unique aspects of each patient, and then individually tailoring interventions to restore physiological, psychological, and structural balance.
Functional medicine focuses on understanding the physiological processes, environmental factors and genetic predispositions that influence health and disease so interventions focus on treating causes, rather than masking symptoms..
It’s not just about popping pills, vitamins or otherwise. It includes blood tests that are not based on normal reference ranges, because
those are not the best reference ranges for optimising health and prevention of disease.
Optimising adult stem cells with exercise and control of glucose and insulin and stress management to lower cortisol ( a hormone which increases with age and causes accelerated ageing) is also important.
Life style change is fundamental including healthy eating — and dispelling the myth that you don’t need supplements if you eat well.
Are there alternatives to the practice of “”blockage medicine”…what do I mean by blockage medicine? Let us take a look at a few chronic medical conditions and explain the “”blockage approach”” and the homeostasis, metabolic normalization approach adopted in integrative medicine.
Autoimmune disease such as graves disease, hashimoto’s and lupus and countless others are most often managed with immune suppressants and / or steroids with any attempt to restore immune system health. Can restoring immune system health be done? The answer is quite frankly YES, but only using the integrative functional approach.
Here follows an example of eradication of grave’s disease using a nutraceutical and hormone balancing approach with detoxification and gut repair, without the use of any thyroid hormone blockers or surgery or radioactive iodine (actual patients in my practice):
The majority of autoimmune diseases occur in women of childbearing age, 1/3 of the cases may have a positive family history, and the incidence of these diseases is increasing dramatically in the last few decades. There are almost 100 autommune diseases according to the NIH released report called Progress in Autoimmunes research published in 2005. Autoimmune disease is more common than coronary artery disease and cancer according to the national centre for health statistics. If autoimmune diseases were notifiable the rate would be even higher! Autoimmune diseases are the eighth leading cause of death in women and shorten the average person’s life by 15 years. (1),(2)
Some theories on the female preponderance of autoimmune diseases include :
Some states cause the thymus to decrease in size or atrophy so that it no longer produces regulatory T cells. Pregnancy is one of them, as is exposure to PCBs (pesticide chemical byproducts) and dioxins and plasticizers. Plasticizers such as bisphenol A, dioxin pesticides, and insecticides are endocrine disruptors and consequently can affect the immune system.
Endocrine disruptors can mimic estrogen and can affect the body by blocking the estrogen receptor site which keeps natural estrogen from the responses it needs to carry on the 400 functions of estrogen in a women’s body-when the estrogen receptors are blocked it prevents the other hormones from sending out their appropriate signals.
Environmental estrogens, such as plastic additives, can exert a direct effect on the immune cells which suppress some of them and overstimulate other immune cells. Having a further look at endocrine disruptors, the acyl hydrocarbon receptor which binds to dioxin and PCBs is found in most tissues. Dioxin and PCBs keep the receptor site turned on too long which can result in an altered immune system.
Polybrominated diphenyl ethers (PBDEs) are a flame-retardant substance that manufacturers use. PBDEs have been found to impair the immune system in animals. Teflon (manufactured with PFOA-perfluorooctanoic acid) also alters the function of immune cells at each major step in the immune pathway.
Developing lupus if they have the genetic predisposition. Occupations that have frequent exposure to paint thinners, removers, mineral spirits, dry cleaning chemicals, aeroplane manufacturable degrease parts), or the leather industry (to strip and tan hides) all have a 2-3 times higher risk of autoimmune diseases such as multiple sclerosis, connective tissue diseases and scleroderma. Other environmental toxins (4),(5) increasing risk include vinyl chloride, trichloroethylene
1. Anti-inflammatory diets may help
a) Paleolithic-Meditaerranean diet
b) Vegan/vegetarian diets
These have proven to clinically show benefit.
Short term fasting (deprives intestinal microbes of food, stimulates intestinal B-cell immunity, improves bactericidal action of neutrophils, raises levels of DHEA (anti-inflammatory immunomodulator), reduces lysozyme release and leukotriene formation, helps gut permeability, results of several studies revealed a substantial reduction in disease activity in many patients, some people have difficulties with foods from the nightshade family (tomato, potato, eggplant, peppers, tobacco)
c) Fatty acid replacement
Always use with antioxidants such as vitamin e; may need to start with a lower dose and work up to a higher dose; EPA/DHA 3000-9000mg;
2. Nutraceuticals and hormonal and vitamin approach
a) DHEA (general effects)
Anti-inflammatory; immunoregulatory hormone (inhibotor of cytokines due to NK-kappa beta inhibition) ; prednisone suppresses dhea ; helps with osteoporosiscaused by prednisone ; use in supraphysiological doses: 200mg most common dose- can go up to 2000mg (not dependant on dhea levels) ; cannot use in patients with breast or prostate cancer ; helps decrease dose or reliance of NSAIDS or disease modifying agents.
b) Excess estrogen, or bad metabolism of estrogen with a low 2:16 OH estrone needs to be corrected
c) Balance other hormones using bioidenticals
d) Treat adrenal insufficiencies and/or adrenal stress
e) Exclude dysbiosis, exclude leaky gut syndrome, 4R (remove offensive agents, replace any deficient enzymes or hcl acid, repopulate and
repair) program if needed to heal the gut
f) Vit d3 has been shown to have autoimmune preventative properties, supplementation supports the immune system, has anti-inflammatory
effects, relieves pain, anti-depressant effect, prevents osteoporosis, dosage adults 4000 iu/d
Once again the blockage approach would be with antidepressants
The integrative approach would be more on the lines of the following in reatoring neurotransmitter health with blocking anything! :
Neurotransmitters are essentially molecules of behavior. There are many of them, but essentially there are the big 5 (dopamine, norepinephrine, acetylcholine, gaba, serotonin)
Functions : motivation, meaning, energy, enthusiasm, power, movement, pain and pleasure, implementation of thought
Excess : impulsive, violence, overdrive
Deficiency : fatigue, addictions, depressive symptoms, ADD, hyperactivity, obesity
Common clinical correlate : parkinsons disease
Regulation of dopamine synthesis :
TH converts tyrosine to L-dopa and is the rate limiting step in dopamine synthesis
TH requires iron as its cofactor
TH is inhibited by iron chelators and iron deficient anemia
Cofactors : vitamin c, copper, niacin
Nutrition : higher protein, smaller meals, carbohydrate restriction
Foods high in tyrosine : rice, leafy vegetables, milk, cottage cheese, curd
Functions : attention, vigilance, focus, sympathetic nervous system, sweating, blood pressure, fight or flight (immediate response)
Excess : anxiety, post traumatic stress disorder
Deficiency : autonomic failure, loss of energy, orthostatic hypotension, abnormal temperature regulation (loss of sweating)
Clinical correlates :
Common symptoms of norepinephrine imbalances :
Regulation of norepinephrine synthesis :
Dopamine – (dopamine beta hydroxylase / DBH)
DBH requires copper and ascorbic acid as cofactors
DBH is inhibited by copper chelators : cysteine and glutathione
Treatment considerations :
Similar to treatments for dopamine since dopamine is the precursor
Norepinephrine also requires methyl donors :
SAM e (S-adenosylmethionine)
Theanine ( a green tea extract, increases dopamine and decreases norepinephrine)
Arginine is an endogenous dopamine and norepinephrine agonist
Natural strategies to reduce excess norepinephrine and anxiety
Inhibit DBH – N-acetylcysteine, Glutathione
Reduce norepinephrine binding – Lacteum (indirect via gaba receptors)
Lower norepinephrine-mediated – DHA
Second messenger activity
Block Norepinephrine release – Theanine (indirect effect via glutamate receptors)
Downregulation of post synaptic – Atomoxetine
Functions : memory, learning, information processing, language
Excess : isolation and paranoia, loss of concentration, burnout
Deficiency : memory loss, agitation, loss of creativity, learning disorders
Clinical correlates : altzheimers dementia, autism (spectral disorders)
phosphatidyl choline + Acetyl CoA
choline + acetyl CoA
Ach + coA
Cofactors : mitochondria support, acetyl L carnitine, taurine
Treatment considerations :
Functions : regulation, balance, integration ( an inhibitory neurotransmitter, antianxiety)
Excess : loss of control, seeking nurturing
Deficiency : tremor, anxiety, insomnia, tension, cardiac dysrhythmias, manic depression, adjustment disorders, OCD, phobias, restlessness, hypertension
Clinical correlates : anxiety, seizures
Gaba imbalances cause :
Glutamate and brain function :
Glutamate imbalance symptoms :
Alpha-keto glutarate + glutamine
Cofactors : inositol, b6, magnesium
Treament considerations :
Pyridoxine (vit b6) effects :
NAC : n-acetylcysteine is a glutamate antagonist by its involvement with the cysteine-glutamate transporter :intracellular cysteine entry in exchange for export of glutamate
Taurine activates gaba a receptors
Functions : sensory integration, excitement, enthusiasm, joy ,challenge
Excess : anxiety, nervousness, tremor, feelings of inferiority and shyness
Deficiency : poor sleep, early arousal, sadness, lassitude, OCD, sugar/carbohydrate craving, irritable bowel syndrome, PMS, pain
Cofactors : b6, magnesium
positive modulation : oxygen, folic acid, sulfhydryl groups, SSRI’s
negative modulaion : Nitric oxide, l-dopa, PCBs, nicotine
Treatment considerations :
Natural serotonin agonists :
Improving the 5htp system:
1) Repetitive exercise using axial muscles
2) Nutritional support : tryptophan (wild game, pork, turkey, chicken, cottage cheese, avocado, eggs)
3) Carbohydrate patterning (simple carbohydrates often craved, so restriction to specific time can improve the system)
4) B-vitamins, 5htp, st john’s wort, zn, mg
The standard approach would be to cut, burn or poison the cancer but isn’t an individualised approach where biochemical individuality, individual toxicity states, chemosensitivity analysis, detoxification issues, the patient as the centre of care rather than the cancer a viable option. The time has come for individualised care for people because they fundamentally are different in their makeup and reposes to various treatments.
Integrative cancer therapies would include :
Some other strategies to consider to personalize treatments would include :
Detoxification and dietary therapies such as gerson
Appropriate dealing with the side effects of chemotherapy
Cancer Vaccines and Immunotherapy
Fighting Specific Problems With Nutrition
Insulin Potentiation Therapy
Natural Substances and their Effects on Cancer Cells
Off Lable Pharmaceuticals in Cancer Treatment
Photodynamic Therapy for Cancer
ZADAXIN and other immune therapies
Cancer Ascorbate Oxidation
Cachexia Malnutrition approach and nutritional support of cancer patients
Complimentary and alternative medicine treatments such as B17 and Ukraine, dmso to name but a few
Conventional approach: Block cholesterol with drugs and heart disease is removed. Is this really true?
Integrative approach :
Opposite to common thought that cholesterol is “bad”, people do need cholesterol for normal bodily functioning. Cholesterol is the precursor to vitamin d, steroid hormones (such as estrogen, progesterone, testosterone, dhea, pregnenolone and cortisol), and the bile acids required for digestion. Cholesterol is also required to form the membrane around cells and for regeneration of damaged endothelial cells.
The main sources of cholesterol are liver production (about 800mg a day). Main dietary sources include meat, cheese, milk and eggs. Cholesterol is transported in the blood by lipoproteins. A healthy cell cannot be overfilled with cholesterol unless the cholesterol is oxidized and enters an already inflamed arterial tissue. Cholesterol is in itself not the culprit here. Nature wouldn’t give you a system designed to kill you. The issue is inability to process cholesterol, inflammation and oxidative stress.
The body’s antioxidant system as well as antioxidant supplements and natural anti-inflammatories safeguard against cholesterol deposition in the blood vessel walls resulting in atherosclerosis (blood vessel disease resulting in heart disease, stroke and peripheral vascular disease).
The reverse cholesterol transport system that removes cholesterol from one’s arteries requires phosphatidylcholine (PC) and LCAT (lecithin cholesterol acyl transferase). LCAT, an enzyme removes a fatty acid particle from PC and binds it to cholesterol producing an ester. HDL, a circulating “good” cholesterol transports this ester back to the liver.
So Good cholesterol includes :
b) Non-oxidized LDL (essential for normal bodily function)
Bad cholesterol :
a) Oxidized LDL….This is the cholesterol that leads to blood vessel Disease. Deposition in blood vessel walls lead to foam cell formation, plaque formation, blood clotting
b) lipoprotein (a)….This is a cholesterol molecule attached to a protein apolipoprotein (a). This molecule has repair function to the arterial wall, however too much of it (usually genetic) promotes formation of bloodclots and build up of plaque. This narrows the blood vessel and worsens symptoms.
It is also important to remember that one can check the degree of inflammation in the body by doing a test called hscrp (highly sensitive crp). A value of less than 1 is normal. Increasing values lead to increases in heart and blood vessel diseases.
If you have a high hscrp natural anti-iflammatories like omega 3 fishoil and curcumin are ideal supplements to lower your risk of cholesterol being oxidized and inflamed in blood vessel walls.
Other risk factors to consider checking for heart disease other than cholesterol include :
Insulin, homocysteine, Lipoprotein (a), hs CRP, fibrinogen, ferritin, oxidative stress/free radicals, toxic heavy metals, stress, blood pressure, genetics
Remember as a rule of thumb that most nutritional supplements work best together rather than as individuals, and you should use natural forms and not synthetic
1. Anti-oxidants to help prevent the oxidation of cholesterol include
a) vitamin e
b) vitamin c
c) co q10
e) alphalipoic acid
h) beta carotene
2. Fish oil
There is overwhelming evidence for the reduced risk of cardiac disease and the use of omega 3 fishoil. Fishoil has enormous health benefits, even over and above cardiovascular disease reduction
The heart and blood vessel benefits include :
a) decreased liporotein (a), triglycerides and blood pressure
b) elevation of hdl
c) reduction of inflammation in the blood vessel walls
d) endothelial function improvement (inner lining of blood vessel walls)
e) makes blood less likely to form clots
f) reverses and stabilizes plaques
g) contributes to the energy of the heart
h) counteracts dysrhythmias (irregular heart beats)
A lot of heart disease sufferers, especially diabetics and postmenopausal women, and acute disease are magnesium deficient. Magnesium helps so many heart conditions including arterial disease, stroke, ischaemic heart disease, heart failure, high blood pressure
An aminoacid that improves nitric oxide, which relaxes arteries, promotes blood flow and keeps them flexible
5. Some supplements to lower bad cholesterol
a) RED YEAST RICE, for example solal’s Cholestaway. A red powder powder produced by the fermentation of a strain of monascus purpureus. It is an antioxidant, may lower LDL cholesterol, increase HDL cholesterol and decrease triglyceride levels. It may inhibit HMG coA reductase as do statin drugs, and Coenzyme q10 supplementation is recommended as with statin drugs. Redyeast rice may also lower LDL cholesterol
Contraindications include :
The usual dosage is 600-2400 mg/d taken as 1 to 4 divided doses
A group of related lipid alcohols (long chain fatty alcohols)
Policosanol may inhibit synthesis of endogenous cholesterol, may inhibit oxidation of cholesterol and may elevate hdl
Usual dosages are 5-20mg /day
300mg / day may compete with cholesterol absorption in the small intestine, thereby reducing absorption of cholesterol
Beta sitosterol is an ingredient in mixed phytosterol products
Beta sitosterol is part of some formulas designed to lower blood cholesterol, treat enlarged prostate (due to 5alpha reductase inhibition)
Or treat endogenous testosterone levels
General therapeutic doses are 60-130mg /day
d) Niacin / nicotinic acid a special form of vitamin b3
Benefits include : Life extension properties due to surtuin gene activation
Cardiovascular benefits include : reversal of atherosclerosis, improvement of blood circulation, helps prevent abnormal blood clotting, may lower heart attack risk, may alleviate raynaud’s disease, lowers LDL, increases HDL, decreases VLDL, may inhibit crosslinking, may lower lipoprotein (a), lowers triglycerides
Side effects include : diarrhoea, nausea, muscle cramps, headaches, dry skin, erythema, flushing
Niacin is an overlooked, wonderful supplement, that has lost favor to statin drugs
Niacin should be revisited and considered by more people wanting natural ways to manage their cholesterol and health
6. Vitamin k2
Mk7 is a form of vitamin k2.
The most familiar vitamin k is vitamin k1 found in green leafy vegetables or supplements.
Vitamin k2 is less easy to find. It is found in fermented Japanese soy dish natto as well as in fermented and curderd cheese.
Both vitamin k1 and k2 are important for the health of the skeletal system as well as the heath of the blood vessel system, but vitamin k2 is the more beneficial. Vitamin k2 supplementation equates to better bone health and heart and blood vessel health
7. ATP/ energy enhancers
A) Coenyzme q10 and solal’s superior form idebenone does so many good things and should be seriously considered for those seeking good health as they get older.
Coq10 does the following :
L_carnitine helps transport fatty acids into the mitochondria to produce ATP (the molecule of energy). It also transports waste ,aterial out of the mitochondria
“A new kid on the block” it rapidly restores depleted energy in sick hearts since it is a building block of ATP
8. Others, and so many more!!
a) Pomegranate juice : lowers blood pressure, reduces oxidized cholesterol, decreases carotid artery wall thickness
b) Garlic contains powerful sulphur and selenium compounds used for the prevention and treatment of diseases for many years
c) B vitamins like b6 , b12, folic acid help lower homocysteine and cardiovascular disease
Balancing hormones with human hormones results in normal homeostasis.
Conventional approach : one size fits all, use pharmaceutical synthetic
It is becoming increasingly accepted that we age prematurely because our hormone levels decline, and that if we restore hormone levels to the optimal range we avoid many of the aging diseases. Hormone deficiency has been linked to diseases like cancer, heart disease, diabetes mellitus, dementia, osteoporosis and osteoarthritis. Other consequences include visual and hearing loss, fractures, frailty, incontinence, obesity, reduced libido and degenerative neurological diseases. Additionally hormone deficiency can cause cancer, such as the low testosterone levels associated with prostate cancer, or the low levels of progesterone involved in breast cancer. In the wake of the controversial Women’s Health Initiative studies, it is crucial to differentiate between toxic and safe hormone replenishment. Bio-identical hormone replenishment is a powerful protective agent against serious diseases. Understanding the difference between bio-identical and non-bio-identical hormones can greatly enhance the quality of life for patients.
Why synthetic, non-bio-identical hormones have so many side effects
Synthetic and pharmaceutical hormones are artificial chemicals that attempt to replicate human hormones. They are structurally foreign to the body. While bio-identical hormones have the identical molecular structure to human hormones, enabling easy metabolism, synthetic hormones are altered to have a different chemical make-up than natural hormones. It is this structural difference that has caused so many side effects over the years in HRT.
The immune system is well-documented to attack anything it perceives as foreign or toxic to the body. From an evolutionary aspect, it takes millennia to become accustomed to a new chemical entity. New foreign chemical entities are fraught with dangers, even in our food. An example is the relatively recent hydrogenation of liquid plant oils into foreign saturated fats and the formation of trans-fats, in food production. These foreign fats have only been around for the last 50 years and they result in increases in heart disease and cancer. Conversely, unsaturated plant oils reduce the risk of heart disease and cancer (eg olive oil, flaxseed oil & canola oil – all rich in omega 3 fats).
Similarly, synthetic non-bio-identical hormones have only been around for less than 50 years, compared to bio-identical ones, which have existed in our bodies since the birth of the human race. These synthetic hormones are associated with increased side effects and can very often be detrimental to your health. If they are used at inappropriate doses, and for too long a time period, or in aging people who have diseased blood vessels, there may be an associated increased risk for very serious medical complications. These complications include breast cancer or thrombotic disorders like deep vein thrombosis, stroke or heart attack. This is made worse if the hormones are administered orally, since the oral route greatly increases the production of blood clotting factors, via the first pass liver effect. This first pass metabolism does not occur with the transdermal route, and so blood clotting risk and thrombosis is reduced this way.
Pharmaceutical hormones like diethylstilbestrol, methyl testosterone, conjugated oestrogens, medroxyprogesterones,and birth control pills have all been linked to cancer.
Why Bio-identical hormones are recommended
In the 1960s Dr Charles Huggins received a Nobel Prize for his work with bio-identical hormones, decreasing the size of cancer tumours. But this work has been overlooked for decades. Today, after the Women’s Health Initiative concluded there are great risks in prescribing synthetic HRT, bio-identical hormones are clearly the safest option.
Bio-identical hormones are entirely the same as human hormones. The chemical structure is the same as that produced naturally in the human body. Bio-identical hormone replenishment is used to restore hormone levels to normal physiological levels, based on blood tests, not at supra-physiological mega doses, based on symptoms alone, as is often the case with non-bioidentical, synthetic hormones. As mentioned previously, these hormones are mostly administered transdermally to avoid first pass metabolism in the liver. Bio-identical hormones are an integral part of maintaining health and a tremendous anti-aging tool.
Bio-identical hormones have been used in Europe and America for over 15 years and are a lot safer, have fewer side effects, and are generally not linked to cancer at all.
The benefits of pharmacy compounding of individualised medicines
Compounded medicines are unique, individualised pharmaceutical products formulated & adjusted to a patient’s specific needs, symptoms or blood results. They allow for flexible dosages, concentrations, combinations and numbers of actives to be incorporated into one product.
Pharmacy compounding has been an essential part of healthcare since the earliest days of pharmacy. It is always prescribed by a physician or doctor in order to meet the needs of patients. As a valued part of today’s healthcare, compounding currently supplies intravenous mixtures, parenteral nutrition solutions, paediatric preparations, and pain-management medications for patients whose medical needs would otherwise go unmet. The following factors continue to influence doctors and their prescribing habits:
a) We cannot always believe information provided by the media which most often reflects the goals of advertisers
b) Consider the money trail (industry, managed care, etc)
c) Citizen response does make a difference
d) The pharmaceutical industry spends huge amounts of money on marketing of patentable non-bio-identical hormones. Bio-identical hormones are not patentable, and thus not profitable for pharmaceutical companies to develop and market.
Typical ages that hormones decline
Human growth hormone
Testosterone, Oestrogen, Progesterone
DHEA (a decline is noted in late 20’s), Thyroid
A good approach to the safe use of hormones includes the following:
a) Correct only deficiencies (avoiding unnecessary treatments)
b) Carefully adjust the doses, personalising them to each individual
c) Doing regular follow-ups (with cancer screening)
d) Using small physiological doses (avoiding overdoses)
e) Correctly balancing the hormone system (rarely use one hormone on its own, because of the risk of unbalancing the system
f) Use bio-identical hormones (avoid synthetic derivatives of natural human hormones
g) Lifestyle changes to lower the risk of cancer are also important, for example: regular exercise; dietary adjustments (eating excessively or cooking at too high temperatures, altering diets high in saturated fat); focusing on positive emotions; nutritional supplementation, eg I3C, DIM, soy, flax and Omega-3.