Allergy Questionaire Release Form - PowerPoint

Document Sample
Allergy Questionaire Release Form - PowerPoint Powered By Docstoc
					Novel Approaches to Managing
   Pain and Inflammation
Functional Medicine Forum Fall/Winter 2003-4
David B. Wood, BS, ND
B.S. Microbiology, Univ. of Washington, 1977
N.D., Bastyr University, 1983
Cofounder/President:
Trinity Family Health Clinic, PS
Cofounder/Vice President/CMO:
Bio-Genesis Nutraceuticals, Inc



12/9/2010
      Recommending a Strategy

Ideas  for Today and Tomorrow
In this presentation I will present
natural nutritional alternatives for
your patients with pain and
inflammation


12/9/2010
            Vision Statement
 The direction in health care today is
  definitely back to a more natural
  approach
 Patients are demanding it and
  published studies are proving that
  natural therapies work


12/9/2010
            Vision Statement
   Patients are more educated today about the
    side effects of drugs and the possible
    nutritional alternatives. It is becoming
    increasingly necessary for physicians to
    know how to integrate diet, nutrition, and
    nutraceuticals into a patients treatment
    plan. Science support this integration and
    patients are asking for it.


12/9/2010
            Goal and Objective
 Know the key mediators of
  inflammation
 Describe the key nutrients and
  botanicals effective in the treatment
  of pain and inflammation
 Be able to effectively utilize specific
  nutrients and botanicals in various
  inflammatory conditions
12/9/2010
          A Partial List of Inflammatory
                    Mediators
 Super oxide radical              Classical complement
 Hydrogen peroxide
                                    pathway
                                   Alternate complement
 Lipid peroxide
                                    pathway
 5 - Lipoxygenase
                                   Tromboxane
 Leukotriene B(4)
                                   Prostaglandin E2 (PGE2)
 Cyclooxygenase
                                   NF Kappa B
 Inflammatory
                                   Arachidonic acid
  cytokines -
    – Tumor Necrosis Factor        Platelet Activating Factor
      alpha (TNF alpha)             (PAF)
    – Interleukins (IL -6 and      Substance P
      IL 1(B))
                                   C-Reactive Protein
    12/9/2010
A Partial List of Conditions
Related to Chronic Inflammation
 Cancer
 Heart Attack - coronary atherosclerosis
 Alzheimer’s disease - damage to brain cells
 Congestive Heart failure - Heart muscle wasting
 Stroke - trombo-embolic events
 Arthritis - damage to joint cartilage/synovial fluid
 Aortic Valve Stenosis - heart valve damage
 Kidney failure - damage to circulation and
  nephrons
 Lupus (SLE) - induce autoimmune attack
 Asthma - close airways
12/9/2010
        A Partial List of Conditions
      Related to Chronic Inflammation
   Psoriasis - induce dermatitis
   Pancreatitis - induce pancreatic cell injury
   Allergy - induce autoimmune reactions
   Fibrosis - attack traumatized tissue
   Surgical complications - prevent healing
   Anemia - attack erythropoietin production
   Fibromyalgia - elevated in fibromyalgia patients
   Metabolic Syndrome X – insulin/cortisol/glucose
    imbalance
               Faloon W. Chronic Inflammation: The Epidemic Disease of
                Aging. Life Extension Foundation. Jan 2002. P13-21.
    12/9/2010
   Available Nutritional Options
 Lifestyle             Modification:
     – Diet (hypoallergenic, balanced CHO/PRO/FAT)

 Natural           Therapeutics:
     – Balanced Functional Foods
     – Omega 3 fatty acids
     – Antioxidants, Vitamin, Mineral and Enzyme
            Cofactors


12/9/2010
    Available Nutritional Options
             Overview Licorice root
                       –
     Botanicals:
                       – Nettles (Urtica
      – Turmeric
                           dioica)
        (Curcumin)
                       –   Ginkgo biloba
      – Boswellia
        serrata        –   Capsaisin –
                           topical
      – Ginger
                       –   Commiphora
      – Feverfew
                           mukul
      – White Willow
                       –   Rosemary
        Bark
12/9/2010
       Available Nutritional Options
                 Overview
 DL Phenylalanine         Homeopathics:
 Bioflavonoids             – Arnica

 Proteolytic               – Bryonia

  Enzymes:                  – Rhus
                              toxicondendron
     – Bromelain
     – Papain
     – Trypsin
     – α Chymotrypsin


12/9/2010
   Available Nutritional Options

 Connective         Tissue Repair Factors:
     – Glucosamine Sulfate (GS)
     – Chondroitin Sulfate (CS)
     – Methylsulfonylmethane (MSM)

 Immune         Modulators
     – Cetyl Myristoleate




12/9/2010
     Lifestyle Modification - Diet
   Food sensitivities are associated with
    increased joint pain and edema in patients
    suffering from episodic joint pain, chronic
    arthralgias, and inflammatory arthritis.
                J R Soc Med 83(5):312-4, 1990
                Ann Allergy 51:260-3, 1983
   Double-blind study - 30 patients (arthritis &
    rheumatism)
     – 22/30 (73.3%) aggravation from provoking foods
            compared to 2/30 (6.6%) of placebo group.
                J Int Acad Prev Med July, 1982, pp. 5-16

12/9/2010
     Lifestyle Modification - Diet
   Balanced CHO/PRO/FAT diets
               Blood sugar balance
               Insulin/Glucagon balance
               good eicosanoid - anti-inflammatory balance
   Balanced Functional Foods:
     – Rx: BioInflammatory Functional Food
               Blood sugar balance
               Cortisol/Insulin/Glucagon balance
               Promote production of anti-inflammatory
                prostaglandins/eicosanoids


12/9/2010
     Lifestyle Modification - Diet
   Eat More foods with a          Eat Less or Avoid foods
    low glycemic index and        with a high glycemic
    high in monounsaturated       index, high in saturated
    fats                          fats and high in
                                  arachidonic acid (AA)
   Salmon & other fish
                                 Fatty cuts of meat
   Oatmeal & whole grains
                                 Organ meats - high in AA
   Olives & olive oil
                                 Egg yolks - high in AA
   Nuts/Seeds and their oils
                                 Pasta, juices, sugar, white
   Fresh fruits & vegetables     rice, white bread - high
   Avocado                       glycemic index

12/9/2010
     Lifestyle Modification - Diet
 Additional            diet references:
     – Werbach M. Nutritional Influences on Illness.2nd
       Ed.Tarzana, CA: Third Line Press; 1993.
     – Pinals RS. Arthritis associated with gluten-sensitive
       enteropathy. J Rheumatol. 1986;13(1):201-204.
     – Kelly VE, Ferretti A, Izui S, et al. A fish oil diet rich
       in eicosapentaenoic acid reduces cyclooxygenase
       metabolism, and suppresses lupus in MRL-lpr mice.
       J Immunol 1985 Mar;134(3):1914-9.
     – Brock TG, McNish RW, Peters-Golden M.
       Arachidonic acid is preferentially metabolized by
       cyclooxygenase-2 to prostacyclin and prostaglandin
       E2. J Biol Chem 1999 Apr 23;274(17):11660-6.

12/9/2010
              Natural Therapeutics -
              Omega 3 Fatty Acids
   Rx: (BioG or FIT) EPA/DHA 1-2 BID -
    TID with meals
   Fish oils (EPA/DHA) are associated with an anti-
    inflammatory effect by inhibiting the 5-
    lipoxygenase pathway, thus reducing the release
    of the superoxide radical and leukotrienes.
     – N Engl J Med 312:1217-23, 1985
   Docosahexaenoic acid (DHA) of fish oil
    suppresses TNF alpha, IL-6, IL-1(B), and
    LTB(4).
     – Faloon W. Chronic Inflammation: The Epidemic Disease
            of Aging. Life Extension Foundation. Jan 2002. P13-21.
12/9/2010
      Natural Therapeutics -
  Vitamins, Minerals, Antioxidants
 Rx: (BioG) Vitamin E 400 high gamma
  fraction 1-2 QD with meal
 Vitamin and Mineral antioxidants have
  been shown to reduce inflammation.
     – Vitamin E (mixed tocopherols) inhibit lipid
       peroxidation.
     – Vitamin E may be as effective in ankylosing
       spondylitis as NSAIDS.
               Nutr Dietary Consult June, 1988


12/9/2010
      Natural Therapeutics -
  Vitamins, Minerals, Antioxidants

 Rx: (TR) Boron 2-3 BID with food
 Boron was effective in approx. 90% of arthritis
    pts., including juvenile arthritis and adult RA
    pts. Pts. Took 6-9 mg elemental boron daily to
    achieve symptom relief then went to 3 mg per
    day for maintenance.
               Int Clin Nutr Rev 11(2):68-70, 1991


12/9/2010
      Natural Therapeutics -
  Vitamins, Minerals, Antioxidants
 Rx: (BioG) OxyATP 1 BID with food
 Selenium with Vitamin E has been shown to
    enhance glutathione peroxidase levels and
    thereby reduce arthritic pain.
     – Proc N Z Workshop on Trace Elements in N Z Dunedin, U.
            of Otago, 1981:92
   Zinc was shown to significantly reduce arthritic
    symptoms in psoriatic arthritis patients in a
    double-blind crossover study
     – Br J Dermatol 103:411-15, 1980

12/9/2010
      Natural Therapeutics -
  Vitamins, Minerals, Antioxidants
   Copper bracelets found to be effective
    treatment for arthritis/rheumatism patients in
    Single-blind Crossover Study: 240
    “arthritis/rheumatism suffers” were randomized into 3
    groups. Gp I wore copper bracelet for 1 mo. Followed
    by a “placebo” bracelet for 1 mo. Gp II wore bracelets
    in reverse order, while Gp. III wore no bracelets.
    Copper bracelets were perceived to be more effective
    (p<0.01).
     – Agents Actions 6:454,1976
     – Werbach, M. Nutritional Influences on Illness 2nd Ed.
            Tarzana, CA. Third Line Press,1993
12/9/2010
      Natural Therapeutics -
  Vitamins, Minerals, Antioxidants

   Copper, Zinc and Manganese have been
    shown to significantly reduce inflammation by
    enhancing superoxide dismutase (SOD)
    production, thus reducing the level of the
    superoxide radical




12/9/2010
              Natural Therapeutics -
               Botanicals/Turmeric
 Rx: (BioG) ArthrogenX 2-3 BID – TID
 Rx: (BioG) PainX 2-3 BID - TID
 Turmeric (Curcumin) has been shown to have
    antioxidant free radical scavenging properties.
    Specifically, curcuminoids have been shown to
    scavenge superoxide anions, hydrogen peroxide
    and inhibit lipid peroxidation. Studies have also
    demonstrated inhibition of lipoxygenase,
    cyclooxygenase, cytokines (TNF alpha and IL -1
    beta.
    – Ramirez-Bosca’ A, et al. Antioxidant curcuma extracts
        decrease the blood lipid peroxide levels of human subjects.
        Age
    12/9/2010 (18):167-9, 1995.
            Natural Therapeutics -
            Botanicals/Curcumin
   Curcumin showed significant subjective
    improvement for Rheumatoid Arthritis
    patients in a randomized, double-blind,
    crossover study. Dosage was 400 mg TID.
    Improvements in morning stiffness, walking
    time and joint swelling were noted.
         Curcuminoids, p 117-121, PDR of
          Nutritional Medicine 1st Ed., Medical
          Economics, 2001

12/9/2010
                Natural Therapeutics -
                Botanicals/Curcumin
   Curcuminoids have been shown to
    significantly inhibit promotion and
    progression stages of colon cancer.
               Kawamori T, Lubert R, Steele VE, et al.
                Chemoprotective effect of curcumin, a naturally
                occuring anti-inflammatory agent, during the
                promotion/progression stages of colon cancer.
                Cancer Res. 1999; 59:597-601.



12/9/2010
            Natural Therapeutics -
             Botanicals/Boswellia
   Boswellia serrata is the source of the spice
  Frankincense. It has been used in traditional
  Indian medicine for the treatment of chronic
  rheumatic inflammation.
 Boswellic acids have been shown to inhibit 5-
  lipoxygenase (the key enzyme in leukotriene
  synthesis).
   Boswellia has also been shown to inhibit both
    the classical and alternate compliment
    pathways.
12/9/2010
                Natural Therapeutics -
                 Botanicals/Boswellia
   Boswellia displayed marked anti-
    inflammatory activity in carrageenan-induced
    edema in rats and mice. It was equally
    effective in adrenalectomized rats. Boswellia
    inhibited elevations of serum transaminase
    enzymes and leukocyte counts
               Singh GB, Atal CK. Pharmacology of an extract of
                salai guggal ex-Boswellia serrata, a new non-
                steroidal anti-inflammatory agent. Agents Actions
                18(3-4):407-12, 1986.

12/9/2010
              Natural Therapeutics -
               Botanicals/Boswellia
   Boswellia has shown promising results with
    patients suffering from inflammatory bowel
    diseases such as: Ulcerative colitis.
     – Experimental double-blind 50 pts, 32-66 yrs old
            grad ll and lll. Reduction in symptoms of:
            abdominal pain, loose stools, mucous, blood,
            and necrotic material was 100% with the
            sulfasalazine grp and 91.7%, 88.9%, 80%,
            86.5% and 79.2% in the boswellia grp,
            respectively.
                – Gupta I et al. Effects of Boswellia serrata gum resin in
                  patients with ulcerative colitis. Eur J Med Res 20:37-
                  43, 1997
12/9/2010
                Natural Therapeutics -
                 Botanicals/Ginger
   Ginger (Zingiber officinalis) has had
    remarkable benefit for arthritic patients. Noted
    areas of improvement have been pain,
    inflammation/swelling, and morning stiffness.
   Gingers mechanism of action appears to be
    its ability to quench 5-lipoxygenase,
    thromboxane, platelet aggregation and its
    dose dependent inhibition of prostaglandin
    (PGE2)
               Werbach M, Murray M. Botanical Influences on Illness
                2nd Ed. Third Line Press Tarzana,CA 2000
12/9/2010
            Natural Therapeutics -
             Botanicals/Ginger
        Sharma JN, Srivastava KC, Gan EK. Suppressive
         effects of eugenol and ginger oil on arthritic rats.
         Pharmacology 49(5):314-8, 1994.
        Kiuchi F, Iwakami S, Shibuya M, et al. Inhibition of
         prostaglandin and leukotriene biosynthesis by
         gingerols and diarylheptanoids. Chem Pharm Bull
         (Tokyo) 40(2):387-91, 1992.
        Flynn DL, Rafferty MF, Boctor AM. Inhibition of
         human neutrophil 5-lipoxygenase activity by
         gingerdione, shogaol, capsaicin and related
         pungent compounds. Prostaglandins Leukot Med
         24(2-3):195-8, 1986.
12/9/2010
       Natural Therapeutics -
        Botanicals/Feverfew
   Feverfew (Tanacetum parthenium)
    reduces inflammation through its inhibition of
    the enzyme phospholipase A2. This
    mechanism effectively inhibits prostaglandins,
    thromboxanes and leukotriene formation at
    the initial stage of synthesis.
 Feverfew is traditionally used in the
    treatment of vascular headaches such as
    Migraines, but due to its anti-inflammatory
    properties may have other uses in the
    treatment of inflammation.
12/9/2010
                 Natural Therapeutics -
                  Botanicals/Feverfew
 Rx: (BioG) MigraClear 1-2 BID
 Feverfew
     – Experimental Double-blind Crossover Migraine
            Study: 57 pts. Significant reduction in pain
            intensity as compared to placebo. Profound
            reduction in vomiting, nausea, sensitivity to noise,
            and light sensitivity
                Palevitch D, Earon G, Carasso R. Feverfew
                 (Tanacetum parthenium) as a prophylactic treatment
                 for migraine: a double-blind placebo-controlled
                 study. Phytother Research 11:508-11, 1997.

12/9/2010
                Natural Therapeutics -
                 Botanicals/Licorice
   Licorice root (Glycyrrhiza glabra) inhibits
  prostaglandin synthesis similar to cortisol.
  Studies have shown that licorice extends the
  half-life of endogenous cortisol. Glycyrrhizin
  may be effective alone or as an adjunct to
  corticosteroid treatment.
 Licorice inhibits: cortisol degradation,
  phopholipase A2, prostaglandin E2,
  generation of ROS by neutrophils.
     – Werbach MR, Murray M. Botanical Influences on Illness
            2nd Ed. Third Line Press, Tarzana, CA 2000.
12/9/2010
                Natural Therapeutics -
                 Botanicals/Nettles
   Stinging Nettles (Urtica dioica) has been
    shown to potently inhibit NF-kappaB activation
    by preventing degradation of IkappaB-alpha,
    its natural inhibitor. NF-kappaB is elevated in
    several chronic inflammatory conditions and
    enhances the expression of proinflammatory
    gene products.
     – Riehmann K, Behnke B, Schulze-Osthoff K. Plant
            extracts from stinging nettle (Urtica dioica), an
            antirheumatic remedy, inhibit the proinflammatory
            transcription factor NF-kappaB. FEBS Lett 442(1):89-94,
            1999.
12/9/2010
            Natural Therapeutics -
             Botanicals/Nettles
 Nettles has also been shown to inhibit
    arachidonic acid, leukotriene B4, and
    cyclooxygenase.
     – Obertreis B et al. [Anti-inflammatory effects of
       Urtica dioica folia extract in comparison to caffeic
       malic acid.] Arzneim Forsch 46:52-6, 1996
     – Werbach M, Murray M. Botanical Influences on
       Illness: A Sourcebook of Clinical Research.
       Third Line Press, Tarzana, CA. 2000


12/9/2010
            Natural Therapeutics -
             Botanicals/Nettles
 Rx: (BioG) BioAllergy Plus 2 TID
 Nettles most recent use has been in the
    treatment of allergic rhinitis or hayfever.
    Freeze-dried Urtica dioica has shown
    moderate favorable benefit for 58% of
    patients in the treatment group as compared
    to 37% of placebo group without sedation or
    stimulation.
     – Mittman, P. Randomized, double-blind study of freeze-
       dried Urtica dioica in the treatment of allergic rhinitis.
       Planta Medica 56:44-47, 1990.
     – Flynn R, Roest M. Your Guide To Standardized Herbal
       Products. One World Press, 1995.
12/9/2010
                Natural Therapeutics -
                 Botanicals/Ginkgo
 Rx: (BioG) Ginkgo Plus 1-2 daily
 Ginkgo biloba inhibits PAF (platelet
    activating factor). PAF is instrumental in
    many inflammatory and allergic processes.
    This would include: neutrophil activation,
    increasing vascular permeability, smooth
    muscle contraction including
    bronchoconstriction and reduction of coronary
    blood flow.
     – Werbach M, Murray, M. Botanical Influences on Illness:
            A Sourcebook of Clinical Research. Third Line Press,
            Tarzana, CA. 2000
12/9/2010
            Natural Therapeutics -
             Botanicals/Ginkgo

   Ginkgo biloba is thought to have its anti-
    inflammatory effect through its
    ginkoflavoneglycosides (kaempferol,
    quercetin, isorhamnetin, prothocyanidins),
    terpenes (ginkgolides and bilobalides).
    Standardized extracts usually contain 24%
    ginkgoflavonglycosides and 6% terpenes.


12/9/2010
         Natural Therapeutics -
         Botanicals/Capsaicin
   Capsaicin - Topical preparations ranging
    from 0.025 to 0.075 % capsaicin derived from
    Cayenne pepper (the fruit of Capsicum
    frutescens) have been effective (range 53-
    100%) in the treatment of cluster headaches,
    neuralgia & neuropathy (including diabetic
    neuropathy), post-herpetic neuralgia,
    postamputation pain, postmastectomy pain,
    psoriasis,and Arthritis (osteo and rheumatoid).
    Dosage is up to 4x/day. Initial burning
    sensation fades over time and rarely
    necessitates cessation of therapy.
12/9/2010
            Natural Therapeutics -
            Botanicals/Capsaicin
   Marks DR et al. A double-blind placebo-controlled trial of
    intranasal capsaicin for cluster headache.
    Cephalalgia13(2):114-16, 1993.
   Ellison N, Loprinzi CL, Kugler J, et al. Pase lll placebo-
    controlled trial of capsaicin cream in the management of
    surgical neuropathic pain in cancer patients. J Clin Oncol
    15(8):2974-80, 1997.
   Epstein J, Marcoe, J. Topical application of capsaicin for
    treatment of oral neuropathic pain and trigeminal neuralgia.
    Oral Surg Oral Med Oral Pathol 77:135-40, 1994.
   Deal CL et al. Treatment of arthritis with topical capsaicin:
    a double-blind trial. Clin Ther 13(3):383-95, 1991.



12/9/2010
                 Natural Therapeutics-
                Botanicals/White Willow
 Rx: (BIOG) PainX 2-3 TID
 White Willow (Salix alba)
  – An extract of willow tree bark is as effective as a
    common prescriptive drug for the treatment of
    low back pain. The study compared the efficacy
    of white willow bark extract to rofecoxib (Vioxx)
    in 228 randomly assigned individuals with low
    back pain treated for a period of 4 weeks. In all
    measures of pain relief WWB was found to be
    as effective as rofecoxib.
               Rheumatology (2001;40:1388-93)
    12/9/2010
             Natural Therapeutics-
            Botanicals/White Willow
 WWB has been used therapeutically for
  2000 years.
 WWB is:
     –      Anti-inflammatory
     –      Antipyretic
     –      Analgesic
     –      Hemostatic
     –      Antithelmintic

12/9/2010
             Natural Therapeutics-
            Botanicals/White Willow
   Common historical uses include:
    – Temporary use in pain: HA, menstrual pain,
        toothache, arthritis, gout, angina, sore
        muscles
    –   Antiseptic for UTIs
    –   Fevers, rheumatic conditions
    –   Inflammatory pain
    –   Connective tissue disorders
    –   Astringent for dysentary, diarrhea, intestinal
        worms and parasites.
12/9/2010
                 Natural Therapeutics-
                Botanicals/White Willow
   Recognized in the United States
    Pharmacopoeia (USP) for 1820 – 1926.
     – Predominated until replaced by cheaper
       synthesized ASA (acetyl-salicylic acid)
     – Better tolerated than ASA
     – Significant differences between WWBE and
       ASA
     – Salicin converted in the liver to ASA, thus
       bypassing gastrointestinal toxicity problems.
    12/9/2010
                 Natural Therapeutics-
                Botanicals/White Willow
 Salicin in WWB appears to suppress the
  production of prostaglandins. It also
  appears to inhibit cyclooxygenase –2
  (Cox-2) and to a lesser degree
  cyclooxygenase – 1 (Cox-1) enzymes.
 Individuals allergic to ASA should avoid
  WWB extracts.

    12/9/2010
       Natural Therapeutics –
    Botanicals/Commiphora mukul
   Commiphora mukul („guggal‟) – has anti-
  inflammatory, antipyretic, antiseptic,
  antispasmodic and antiatherogenic properties.
 Common traditional uses –
    – Neuralgia, rheumatism, muscle spasms,
      inflammation and many infections
    – Considered a strong anti-inflammatory
   Modern day uses –
    – Reduction of elevated cholesterol and
      triglycerides via its guggulsterones E and Z.
    12/9/2010
       Natural Therapeutics –
    Botanicals/Commiphora mukul
   Commiphora mukul –
    – Experimental arthritis (animal) study: albino rabbits
       induced by intra-articular injection (Rt hock joint) of killed
       mycobacterium adjuvant. Designed to produce replica
       of human rheumatoid arthritis. Phenylbutazone,
       ibuprofen and fraction “A” of gum-guggual were all
       shown to be effective in reducing thickness of joint
       swelling. Commiphora mukul compared favorably and
       was beneficial in the treatment of experimental arthritis.
            Sharma JN, Sharma JN. Comparison of the anti-
             inflammatory activity of Commiphora mukul (an indigenous
             drug) with those of phenylbutazone and ibuprofen in
             experimental arthritis by mycobacterial adjuvant.
             Arzneimittelforschung 1077 Jul;27(7):
             1455-7
    12/9/2010
       Natural Therapeutics –
    Botanicals/Commiphora mukul
   Commiphora mukul:
    – Experimental inflammatory (animal) study: Myrrhanol A,
       a new triterpene isolated from guggul (Balsamodendron
       or Commiphora mukul Hook) – gum resin, displays
       potent anti-inflammatory effect on exudative pouch fluid,
       angiogenesis, and granuloma weights in adjuvant air-
       pouch granuloma of mice. Its effects were more marked
       than hydrocortisone.
            Kimura I, Yoshikawa M, Kobayashi S, Sugihara Y, Suzuki M,
             Oominami H, Murakami T, Matsuda H, Doiphode VV. New
             triterpenes, myrrhanol A and myrrhanone A, from guggul-
             gum resins, and their potent anti-inflammatory effect on
             adjuvant-induced air-pouch granuloma of mice. Bioorg Med
             Chem Lett. 2001 Apr 23;11(8):985-9.
    12/9/2010
       Natural Therapeutics –
    Botanicals/Commiphora mukul
    Singh BB, Mishra L, Aquilina N, Kohlbeck F. Usefulness
     of guggul (Commiphora mukul) for osteoarthritis of the
     knee: An experimental case study. Altern Ther Health
     Med. 2001 Mar;7(2):120, 112-4.
    Duwiejua M, Zeitlin IJ, Waterman PG, Chapman J,
     Mhango GJ, Provan GJ. Anti-inflammatory activity of
     resins from some species of the plant family Burseraceae.
     Planta Med. 1993 Feb;59(1):12-6.
    Arora RB, Taneja V, Sharma RC, Gupta SK. Anti-
     inflammatory studies on a crystalline steroid isolated from
     Commiphora. Indian J Med Res. 1972 Jun;60(6):929-31.
    12/9/2010
             Natural Therapeutics -
        Botanicals/Rosmarinus officinales
 Rosmarinus officinales (Rosemary): contains
  rosmaricine, aromatic essential oils, diosmin,
  beneficial minerals (Ca, Mg, P, Na, K).
 Reported uses have been:
    – Smooth muscle stimulant
    – Analgesic, antioxidant, antibacterial and antiviral
    – Soothe and calm irritated nerves)
    – Soothe irritated stomach
    – Balance electrolytes
    – Lower elevated blood pressure
    – Decrease capillary permeability/fragility (diosmin) Stronger
        than rutin
    12/9/2010
             Natural Therapeutics –
         Botanicals/Rosmarinus officinalis
     Reported uses con‟t:
       – Europe/China – Headaches
       – Europe/China – Stomach pains/dyspepsia
       – Europe/America – Cholagogue
       – Antitumorigenesis (animal/mammary)
       – Germany – quickens and quiets circulation and relieves
         symptoms of rheumatism and neuralgia
       – German Commission E approved for internal and external
         use.
     Avoid large doses: gastrointestinal irritation, kidney irritation.
      Has been used as an abortifactant in very large doses. Several
      gram doses should not be used during pregnancy.

    12/9/2010
             Natural Therapeutics –
         Botanicals/Rosmarinus officinalis
   Blumenthal, M (Ed): The Complete German Commission E
    Monographs: Therapeutic Guide to Herbal Medicines. American
    Botanical Council. Austin, TX. 1998.
   Aruoma, OI, et al. An evaluation of the antioxidant and antiviral
    action of extracts of rosemary and Provencal herbs. Food Chem.
    Toxicol. 1996, 34(5): 449-456.
   Singletary KW, Nelshoppen JM. Inhibition of 7,12-
    dimethylbenz(a) anthracene (DMBA)-induced mammary
    tumorigenesis and of in vivo formation of mammary DMBA-DNA
    aducts of rosemary extract. Cancer Lett. 1991, 60(2): 169.
   Fitzpatrick, FK. Plant substances active against mycobacterium
    tuberculosis. Antibiotics and Chemotherapy, 4(5), 528-536, 1954.



    12/9/2010
         Natural Therapeutics-
        Nutritional Options/DLPA
       DL-Phenylalanine (DLPA): may have
        analgesic properties thought to be
        through DPA‟s blockage of enkephalin
        degradation by the enzyme
        carboxypeptidase A.
            – DLPA should be avoided by those with
             PKU and those taking MAO inhibitors.


12/9/2010
     Nutritional Therapeutics-
 Nutritional Options/Bioflavonoids
       Hesperetin/Hesperidin (glycoside form of
        Hesperetin):
            – phenolic antioxidant.
            – Anti-inflammatory via interference with
                metabolism of arachidonic acid (AA) and
                histamine release.
            –   Inhibits phospholipase A
            –   Inhibits lipoxygenase
            –   Inhibits cyclo-oxygenase
            –   Decreases microvasculature permeability
12/9/2010
     Nutritional Therapeutics-
 Nutritional Options/Bioflavonoids
       Quercetin/Rutin (Quercetin-3- rutinoside):
            – Phenolic antioxidant
            – Anti-inflammatory via:
                  Inhibition of lipid peroxidation
                  Inhibits degranulation of mast cells, basophils and
                   neutrophils
                  In vitro and animal studies show that quercetin
                   inhibits tyrosine kinase, nitric oxide synthase and
                   modulates activity of the inflammatory mediator NF-
                   kappa B.
                  Inhibits formation of inflammatory prostaglandins
                   and leukotrienes.

12/9/2010
             Natural Therapeutics-
             Proteolytic Enzymes
       Bomelain: contains:
     4+cysteine proteases
     Acid phosphatase
     Peroxidase
     Amylase
     Cellulase
     Stem proteases: ananain and comosain
    Bromelain’s uses:
    •   Speeds healing time
    •   Pain reduction (post surgery and athletic injuries)

12/9/2010
               Natural Therapeutics-
               Proteolytic Enzymes
       Bomelain:
       Open study, 59 patients with blunt injuries to
        M/S system.
            – Clear reduction in swelling, pain at rest and during
              movement and in tenderness reported.
            – Most common method of expressing Activity in
              GDU (gelatin digesting units) or MCU (milk clotting
              units)
            – 1 GDU approx. = to 1.5 MCU

12/9/2010
                Natural Therapeutics-
                Proteolytic Enzymes
       Bromelain:
     Anti-inflammatory mechanism not well
      understood
     Possible mechanisms:
            – Activation of plasmin production from plasminogen
            – Reduction of kinin via inhibition of conversion of
              kininogen to kinin.
            – Proteolytic degradation of circulating immune
              complexes (CIC)
            – Inhibition of signaling by extracellular regulated kinase
              (ERK)-2 and p21ras.

12/9/2010
                Natural Therapeutics-
                Proteolytic Enzymes
       Bromelain:
            – Kumakura S, Yamashita M, Tsurufuji S. Effects of
              bromelain on kaolin-induced inflammation in rats. Eur J
              Pharmacol. 1988; 150:295-301.
            – Masson M. [Bromelain in blunt injuries of the locomotor
              system. A study of observed applications in general
              practice]. [Article in German]. Fortschr Med. 1995;
              113:303-306.
            – Mynott RL, ladhams A, Scarmato P, Engwerda CR.
              Bromelain from pineapple stems, proteolytically blocks
              activation of extracellular regulated kinase-2 in T cells.
              J Immunol. 1999; 163:2568-2575.
            – PDR for Nutritional Supplements, 1st Ed. Medical
              Economics/Thomson Healthcare. 2001.

12/9/2010
              Natural Therapeutics -
                 Homeopathics
   Arnica Montana:
     – Inflammation from injuries, falls, blows, bruises
            and contusions. Strains, sprains. Muscular tonic.
            Sore, lame, bruised feeling. Neuralgias,
            rheumatism (fibromyalgia?).
   Bryonia:
     – Aching in every muscle. Stitching, tearing pain,
            worse by motion, better rest. Rheumatic pains
            and swellings. Joints red, swollen, hot.


12/9/2010
             Natural Therapeutics -
                Homeopathics
   Rhus Toxicondendron:
     – Inflammation/pain of skin, mucous
            membranes, joints, tendons, ligaments,
            fascia, sheaths - aponeurosis and muscles.
            Rheumatic pain. Tearing asunder pains.
            Ailments from strains, overlifting.
            Rheumatism in cold season. Motion
            limbers up. Worse cold, rest.


12/9/2010
             Natural Therapeutics -
                Homeopathics
       Consideration of other common
        homeopathics:
            – Aconite, Belladonna, Bellis perennis, Calendula,
              Chamomilla, Echinacea, Hamamelis, Hypericum

       For acute perscribing or if perscribing in
        concert with botanicals, enzymes,
        antioxidants, etc:
            – Rx: stick with low potencies which can be
              repeated often and carry less concern for
              neutralizing effect or „proving‟ the remedy
12/9/2010
             Natural Therapeutics -
            Connective Tissue Factors
 Rx:           (BioG) ArthrogenX
               2 - 3 BID - TID with meals
 Glucosamine  sulfate
 Chondroitin sulfate
 Methylsulfonylmethane (MSM)
 Rx: (BioGP PainX
               2-3 BID – TID between meals

12/9/2010
            Natural Therapeutics -
             Glucosamine sulfate
   Glucosamine sulfate(GS) is one of several
  naturally occurring amino sugars that are
  essential for rebuilding and healthy
  maintenance of connective tissue, including
  tendons, ligaments, cartilage and bone matrix.
 Increased age is associated with glycation of
  cartilage that reduces the production of
  proteoglycans involved as joint lubricants. GS
  is an essential component of proteoglycans
  and may be required to re-establish
  proteoglycan levels.
12/9/2010
            Natural Therapeutics -
             Glucosamine sulfate
   Meta-analysis of thirteen double-blind placebo-
    controlled clinical trials revealed that GS was superior
    to placebo in all thirteen studies, as measured by
    global pain scores or the Lequesne index.
   Patients receiving GS have a gradual and progressive
    reduction in joint pain and tenderness, as well as
    improved range of motion and walking speed.
   GS is also reported to be equally or more effective
    than ibuprofen, and is better tolerated than ibuprofen.
   GS needs to be stabilized with either NaCl or KCl for
    maximum effectiveness.

12/9/2010
        Natural Therapeutics -
         Glucosamine sulfate
   De Camara C, et al. Glucosamine sulfate for
    osteoarthritis. Ann Pharmacother 32(5):580-7, 1998.
 Qiu, G et al. Efficacy and safety of glucosamine
    sulfate versus ibuprofen in patients with knee
    osteoarthritis. Arzneimittelforschung 48(5):469-74,
    1998.
 Deal C, et al. Nutraceuticals as therapeutic agents in
    osteoarthritis. The role of glucosamine sulfate,
    chondroitin sulfate, and collagen hydrolysate. Rheum
    Dis Clin North Am 25(2):379-95, 1999.
 Drovanti A, et al. Therapeutic activity of oral
    glucosamine sulfate in osteoarthrosis: A placebo-
    controlled double-blind investigation. Clin Ther 3,
    260-272, 1980.
12/9/2010
            Natural Therapeutics -
             Chondroitin sulfate
   Chondroitin sulfate (CS) is a glycosaminoglycan that is
    a major component of cartilage, is rich in sulfur, and
    related to GS.
   CS helps to hold water and nutrients in joint tissue, and
    enhances the circulation of nutrient molecules in
    cartilage.
   Meta-analysis performed on seven randomized,
    double-blind clinical trials using CS showed it to be
    significantly superior to placebo with respect to the
    Lequesne index and other pain scores.

12/9/2010
            Natural Therapeutics -
             Chondroitin sulfate

   Leeb B, et al. A meta-analysis of condroitin sulfate in the
    treatment of osteoarthritis. J Rheumatol 27(1):205-11,
    2000.
   Deal C, et al. Nutraceuticals as therapeutic agents in
    osteoarthritis. The role of glucosamine, chondroitin
    sulfate, and collagen hydrolysate. Rheum Dis Clin North
    Am 25(2):379-95, 1999.
   Morrison M. Therapeutic applications of chondroitin-4-
    sulfate, appraisal of biologic properties. Folia Angiol 25,
    225-232, 1977.


12/9/2010
            Natural Therapeutics -
            Methylsulfonylmethane
   Methylsulfonylmethane (MSM) is a source of organic
    sulfur found naturally in the human body.
   MSM is a stable metabolite of DMSO and is 34%
    elemental sulfur.
   MSM supports many functions, including maintenance
    of connective tissue. Collagen basement membrane,
    procollagen and collagen are partially dependent on
    dietary sulfur.
   MSM has been found to lessen destructive changes in
    joints.


12/9/2010
            Natural Therapeutics -
            Methylsulfonylmethane

   Murav‟ev V, et al. Effect of dimethyl sulfoxide and
    dimethyl sulfone on a destructive process in the
    joints of mice with spontaneous arthritis. Patol Fiziol
    Eksp Ter (2):37-9, 1991.




12/9/2010
            Natural Therapeutics -
             Immune Modulators
   Cetyl myristoleate (CM) is a naturally
  occurring ester of a myristoleic acid that is
  commercially obtained from palmitic acid.
 An investigation into why mice do not get
  arthritis led to the discovery of CM as the
  responsible agent.
 In a study of rats injected with an arthritis-
  producing material, the CM group was healthy
  and had virtually no signs of arthritis, whereas
  the control group was unhealthy and had
  severe swelling.
12/9/2010
                  Natural Therapeutics -
                   Cetyl myristoleate
   Cetyl myristoleate is thought to have several
    mechanisms of action:
     – CM serves as a lubricant for the joints
     – CM functions as an immune modulator.
     – CM mediates the inflammatory process by
            promoting a balanced T Helper1 to T Helper2
            cellular response.
                Diehl H, et al. Cetyl myristoleate isolated from Swiss
                 albino mice: an apparent protective agent against
                 adjuvant arthritis in rats. J Pharm Sci 83(3):296-9,
                 1994.

12/9/2010
Boswellia,
Ginger,
               Nettles,
              Turmeric,
              Feverfew




    Nettles
                          Ginger
                                   Licoric
                                   e

  12/9/2010
    Summary - Natural Inhibitors of
       Inflammatory Mediators
   Hypoallergenic, CHO/PRO/FAT balanced diets
    (nutrient dense)
               All inflammatory mediators
   Omega 3 fatty acids
               5 - lipoxygenase, TNF alpha, IL-6, IL-1(B),
               Leukotriene B(4)
               Super oxide radical
   Antioxidants, Vitamins, Minerals
               Vitamin E/Selenium - lipid peroxide
               Boron - ?enhancement of Testosterone, Estrogens,
                DHEA, and Vitamin D.
               Copper, Zinc, Managanese - Superoxide radical
12/9/2010
    Summary - Natural Inhibitors of
       Inflammatory Mediators
   Botanicals
     – Turmeric (Curcumin)
         Super oxide radical

         Hydrogen peroxide

         Lipid peroxide

         5 - lipoxygenase

         Leukotrienes

         Cyclooxygenase

         Inflammatory cytokines (TNF alpha, IL - 1
          beta)
12/9/2010
    Summary - Natural Inhibitors of
       Inflammatory Mediators
   Botanicals
     – Boswellia serrata
         5 - lipoxygenase

         Leukotrienes

         Classical complement pathway

         Alternate complement pathway




12/9/2010
    Summary - Natural Inhibitors of
       Inflammatory Mediators

   Botanicals
     – Ginger
         5 - lipoxygenase

         Leukotrienes

         Thromboxane

         PGE2

         Platelet aggregation



12/9/2010
    Summary - Natural Inhibitors of
       Inflammatory Mediators

   Botanicals
     – Feverfew
         Phospholipase A2 - inhibiting at

          initiation step of:
            – Prostaglandins
            – Thromboxanes
            – Leukotrienes

12/9/2010
    Summary - Natural Inhibitors of
       Inflammatory Mediators
   Botanicals
     – Licorice
         Phospholipase A2 - inhibiting at the initiation

          step of:
            – Prostaglandins (PGE2)
         ROS

         Inhibits degradation of cortisol




12/9/2010
    Summary - Natural Inhibitors of
       Inflammatory Mediators

   Botanicals
     – Nettles
         NF Kappa B

         Arachidonic Acid

         Leukotriene B4

         Cyclooxygenase




12/9/2010
    Summary - Natural Inhibitors of
       Inflammatory Mediators
   Botanicals
     – Ginkgo biloba
         PAF (Platelet Activating Factor)

     – Capsaicin (topical)
         Substance P

   Immune Modulators
     – Cetyl Myristoleate
         Cytokines (TNF alpha, IL - 1beta - via
          regulation of T Helper 2 cell activity)

12/9/2010
  Suggested Clinical Work-up and
  Protocol for a Patient with Pain
        and Inflammation
   R/O Hypersensitivity (Food/Environmental)
     – Elimination/Challenge Diet
     – Allergy testing
               IgE - Environmental (Immediate)
               IgG - Food (Delayed)
 Balanced Whole Food Hypoallergenic
  Nutrient Dense Diet
 Adequate Pure Water, Rest, Exercise, Stress
  Reduction

12/9/2010
  Suggested Clinical Work-up and
  Protocol for a Patient with Pain
        and Inflammation
   Check morning urine/saliva pH
     – Correct Acidosis if present
     – Ideal pH (6.4 - 7.0)
   R/O Digestive deficiencies and Intestinal
    Dysbiosis
     – Rx stool analysis (Digest/Microbial/P1,2,or3)
   Routine Labs/Procedures for DDx (if no
    definitive Dx) and monitoring
12/9/2010
  Suggested Clinical Work-up and
  Protocol for a Patient with Pain
        and Inflammation
   Liver Detoxification Evaluation
     – Assess Phase l and Phase ll functional
            detox capacity
   Oxidation/Reduction
     – Assess ability to quench ROS




12/9/2010
                   Laboratories Providing
                     Suggested Tests
   Some labs to contact for information on available
    screening tests:
    – Doctor’s Data, Inc
               (1-800-323-2784) www.doctorsdata.com
         Digestive/Microbial Stool testing, Toxic minerals
          
         screening
    – Metametrix Clinical Laboratory
        (1-800-221-4640) www.metametrix.com

        Organix, Food/Inhalant allergy panels, Oxidative
         Stress Indicators, Nutrient and Toxic Elements
         testing, Amino Acids, Fatty Acids, Bone Resorption,
         Estronex, ION Panel
    12/9/2010
 Suggested Clinical Work-up and Protocol
 for a Patient with Pain and Inflammation
 Nutritional Rx:
 Balanced Hypoallergenic Functional Food for
  detoxification support, reduction of inflammation and
  correction of nutrient deficiencies
   – Rx: (BioG) BioInflammatory Functional Food
 Combination of GS, CS, MSM (if connective tissues,
  especially if joints involved) to supply 1500 - 2500 mg
  organic sulfur/day
   – Rx: (BioG) ArthrogenX 2-3 BID - TID with meals
   – Rx: (BioG) PainX 2-3 BID – TID between meals


12/9/2010
     Suggested Clinical Work-up and Protocol
     for a Patient with Pain and Inflammation
   Natural Anti-inflammatory Standardized Botanicals
    (Typically given in a combination capsular form):
         Rx: (BioG) ArthrogenX 2-3 BID - TID with meals or
          Rx: (BioG) PainX 2-3 BID – TID between meals
                – Or single herbs:
                   • Ginger        150 - 300 mg QD, Turmeric 300 - 600 mg
                      QD, Boswellia 300 - 600 mg QD
   Single Ingredient or BioG Combination Formulas:
                – Nettles 300 - 500 mg TID (if environmental allergies
                  present) Rx: (BioG) Allergy Plus
                – Ginkgo      60 - 120 mg QD - BID (if (+) for vascular
                  insufficiency) Rx: (BioG) Ginkgo Plus
                – Feverfew   50 - 100 mg QD (if (+) for vascular headaches)
                 Rx: (BioG) MigraClear
    12/9/2010
      Additional References Novel
    Approaches to Managing Pain and
              Inflammation
   Brod SA. Unregulated inflammation shortens human
    functional longevity. Inflamm Res 2000 Nov;49(11):561-70.
   McCary MF. Interleukin-6asa central mediator of
    cardiovascular risk associated with chronic inflammation,
    smoking, diabetes, and visceral obesity: down-regulation with
    essential fatty acids, ethanol and pentoxifylline. Med
    Hypotheses 1999 May;52(5):465-77.
   Kremer JM. n-3 fatty acid supplements in rheumatoid arthritis.
    Am J Clin Nutr 2000 Jan;71(1Suppl):349S-51S.
   Upritchard JE, Sutherland WH, Mann JI: Effect of
    supplementation with tomato juice, vitamin E, and vitamin C on
    LDL oxidation and products of inflammatory activity in type 2
    diabetes. Diabetes Care 2000 Jun;23(6):733-8.
12/9/2010
     Additional References for Novel
    Approaches to Managing Pain and
              Inflammation
   Langlois M, Duprez D, Delanghe J: Serum vitamin C
    concentration is low in peripheral arterial disease and is
    associated with inflammation and severity of
    atherosclerosis. Circulation 2001 Apr 10;103(14):1863-8.
   Horton JW, White DJ, Maass DL: Antioxidant vitamin
    therapy alters burn trauma-mediated cardiac NF-kappaB
    activation and cardiomyocyte cytokine secretion. J Trauma
    2001 Mar;50(3):397-408.




12/9/2010
 Novel Approaches to Managing Pain and
             Inflammation
                   Conclusion
 Natural nutritionals along with a healthy diet
  and lifestyle can have dramatic positive
  benefits for patients with acute and chronic
  inflammatory conditions!
 Start integrating natural anti-inflammatory
  therapies into your patient management today.
   David B. Wood, ND
     – dwoodnd@bio-genesis.com
     – dwoodnd@trinityclinic.com


12/9/2010
            Stuff to Take
               Home

12/9/2010
   Clinical Protocols


12/9/2010
               Allergies (Food)
   R/O with laboratory testing (IgG ELISA or
    Elimination/Challenge diet. This is a good time to do
    the BioCleanse Detox program.
   Avoid 3+ or higher foods, Rotate others
   Desensitize with homeopathic dilutions of allergens
    (Apex)
   Run Digestive/Microbiol/P testing, Organix or
    Lactulose/Mannitol testing to assess level of gut
    dysbiosis, permeability and/or digestive enzyme
    deficiencies

12/9/2010
               Allergies (Food)
   Remove any bowel pathogens with ParaBiotic Plus (2
    TID)
   Consider reforestation of bowel with products such
    as: Florastor (Biocodex) (2 BID) and ProFlora Plus
    caps (3 BID). Initiate this treatment after completing
    ParaBiotic Plus phase.
   Repair mucosal barrier/gut lining with: Intestinal
    Repair Complex (1 tsp BID-TID)



12/9/2010
        Allergies (Environmental)
   Seasonal?
     – Late February to Mid April? Probably Deciduous
       Tree Pollens
     – Mid April to Mid July? Probably Grass/Weed
       pollens
     – Year around? Probably dust mite or mold allergy
   Evaluate symptomatically or allergy test with IgE
    serum testing or skin testing.



12/9/2010
        Allergies (Environmental)
 Reduce exposure (air cleaners, electrostatic
  precipitators, etc.)
 Desensitize with homeopathic allergens (Heel, Apex,
  Professional Complimentary Health)
 Rx: BioAllergy Plus capsules (2-4 caps TID - QID
  between meals)
 Rx: NAC (1-2 BID without food)
 Rx: Immune Balancing Complex (T cell balancing)
 (1-2 BID with food)


12/9/2010
            Adrenal Insufficiency
 Check for postural hypotension (Lying to standing
  blood pressure evaluation). I consider it significant if
  the systolic pressure drops by 8 points or more.
 Serum Sodium less than 140. My optimal is 140-142
 Test Salivary (or Serum hormones) Hormones to
  check for deficiency and/or circadian rhythm
  disturbances.
 Fatigue after exercise and history of slow recovery.
  Takes 2-3 days to recover from stress, exercise, etc.


12/9/2010
            Adrenal Insufficiency
   Rx: BioAdreno 2 with breakfast and 1 with lunch. Do
    not give later in the day.
   Rx: BioAdaptogen 1-2 capsules up to TID between
    meals
   Rx: Adrenal Support Plus 1-2 per meal
   Rx: Celtic salt to replace regular table salt (to taste)
   Rx: Lipopure PS/PC oral spray to enhance HPA axis
    regulation (2 sprays before bed)
   Rx: Zone balanced regular meals. UltraLean
    (powder and bars) or UltraPure Whey protein to
    assist (1SVG/day)
   Rx: Stress reduction, gentle exercise
12/9/2010
              Arthritis
 R/O DJD vs. RA
  – exam
  – family history
 Zone Balanced Diet




12/9/2010
                    Arthritis
 Rx:
   – BioInflammatory Functional Food (1 Svg/day)
   – ArthroGenx capsules (2-3 TID with meals)
   – PainX (2-3 TID between meals)
   – EPA/DHA (2-3 BID with meals)
   – OsteoGenesis regular or E.S. (2 TID with meals)
 Labs recommended:
   – Organix or Digestive/Microbiol/Parasite
   – Allergy evaluation (Elimination/Challenge, IgG
     ELISA)
   – Urine/Saliva pH screen (r/o acidosis)
   – serum autoantibodies (if unsure)

12/9/2010
                Autoimmune Disorders
    Run labs to further assess patients nutritional needs:
      – Organix
      – Allergy (IgG, Elimination/Challenge)
      – Zinc Tally taste test
      – Postural Hypotention Adrenal Insufficiency Screen
      – urine/saliva pH
    Correct Dysbiosis
      – (ParaBiotic Plus, Florastor, ProFlora Plus caps,
        Intestinal Repair Complex) ParaBiotic Plus and IRC
        can be given together. Florastor and ProFlora Plus
        caps should be started after completing the
        prescribed course of ParaBiotic Plus.

    12/9/2010
            Autoimmune Disorders
   Treat T Helper 1/T Helper 2 cell imbalance:
     – (Immune Balancing Complex, Moducare (Th),
       Tocotriene Complex (PRL)
   Quench Inflammatory Mediators and assist in
    balancing Phase 1/Phase 2 detoxification pathways:
     – (BioInflammatory Functional Food,
       BioInflammatory capsules, BioAlkalizer, PainX,
       ArthroGenx, EPA/DHA)



12/9/2010
            Breast Disorders
 CRT testing to further define breast cancer
  risk
 Estronex urine testing to evaluate
  2OH Estrone/16alphaOH Estrone ratio (risk
  factor)
 Breast exam
 Mammogram (if warranted)



12/9/2010
             Breast Disorders
   Hormone balancing: often reduction of estrogen
    dominance symptoms.
     – BioCleanse powder detox for 2 weeks followed by
       ongoing use of BioCleanse caps (Calcium D-
       Glucarate, Broccoli extract) (2 BID to TID)
     – BioIsoflavone caps (Soy Isoflavones)
     – DIM PRO PLUS (FIT) (1 BID)
     – EPA/DHA (2-3 BID with meals)
     – Lipopure Progesterone especially if patient also
       has PMS, uterine cramping, and/or heavy
       prolonged menses (dosage varies - see product
       sheet)
12/9/2010
                     CFIDS
   R/O the basics: anemia, clinical or subclinical
    hypothyroid (labs + temps), hypoglycemia,
    circadian rhythym disorders (sleep/melatonin,
    adrenal hormones/postural hypotension),
    chronic virus (EBV, CMV), pleomorphic
    organism (Chlamydia pneumoniae,
    Mycoplasma fermentens), intestinal
    dysbiosis, allergy/leaky gut, T Helper 1/T
    Helper 2 imbalance, depression.

12/9/2010
                       CFIDS
   Clean up the diet (Zone balanced whole foods) and
    establish a routine
     – often patient eats on the run. Eats fast food.
       Doesn‟t eat on a schedule
   Rx: depending on findings
     – Possible use of: (BioCleanse Functional Food,
       BioAdreno, BioAdaptogen, Adreanl Support Plus,
       Lipopure Melatonin, Lipopure PS/PC, GlucoTone,
       MycoPotent Immune Complex, Immune Balancing
       Complex, ParaBiotic Plus, Florastor, ProFlora Plus
       caps, UltraHematinic and/or Lipopure B12/Folate
       oral spray)

12/9/2010
            Cholesterol Elevation
 Diet: Low fat, high fiber. Zone balanced. Whole
  foods. Variety of fresh fruits/vegetables.
 Exercise: 3-5 x/week combination cardio/weights.
  Duration/intensity according to doctors instructions
 Rx‟s:
 BioLipotrol (2 TID) or (3 BID) lower dosage if mild
  elevation.
 Functional Food (if needed): BioCleanse or UltraLean
  or Metabol-X
 Garlic 7000 (1-2 BID)


12/9/2010
            Cognitive Dysfunction
   Patient complains of Simple Memory disorder
    (short term)
   Zone balance diet to protect against
    hypoglycemic short term memory loss
   BioFocus (1 SVG/day)
   Ginkgo Plus (1-2 BID) Contraindicated if
    patient is on anticoagulant Tx.
   Lipopure PS/PC (2-4 sprays BID, swish, hold
    in mouth 2-3 min. swallow)

12/9/2010
            Cognitive Dysfunction
   EPA/DHA (2-3 BID with meals)
   R/O anemia, hypothyroid, atherosclerosis (lipid
    panel)
   Anemia: UltraHematinic (1 TID with meals), if
    macrocytic- Lipopure B12/Folate oral spray 2 sprays
    BID)
   Hypothyroid: BioThyro 2 caps QD-BID without food
    and possible Rx natural thyroid medication
   Elevated Lipids: BioLipotrol 2-3 BID to TID with meals


12/9/2010
               Colon Disorders
            (IBS, Colitis, Crohn‟s)
   Labs:
   Organix (urine) or
    Digestive/Microbiol/Parasite (stool)
   Allergy (IgG, or Elimination/Challenge)
   Hemocult (if DMSP above not done)
   Colonoscopy (if indicated)



12/9/2010
               Colon Disorders
            (IBS, Colitis, Crohn‟s
   Rx:
   Intestinal Repair Complex - 1tsp BID to TID
   L-Glutamine powder 1tsp BID to TID
   Intestinal Repair Caps 2 TID with meals
   Vitamin E 400 1-2 QD to TID (high levels can be
    used to enhance SIgA production in patients with low
    levels. Also Dr. Bastyr recommended to stop
    bleeding within 4 days!)
   UltaPure Whey protein - 1-2 SVG/day (if tolerant to
    Whey) good source of glutamine and very high in
    immunoglobulins
   Hypoallergenic/soluble fiber (FIT)
12/9/2010
 Detoxification (Heavy Metals)
 Assessment: Urine DMSA Challenge or Hair
  Elements Analysis. Questionnaire indications
  of environmental or drug toxicity. In office
  screens – high probability score on
  multisymptom questionaire or S.O.S.
  questionaire.
 Typical Rx‟s:
   – Metal Cleanse oral drops: ½ tsp BID
   – Toxi HMF 2 - 3 capsules BID without food

12/9/2010
 Detoxification (Heavy Metals)
   Rx‟s continued:
     – BioCleanse Functional Food: – follow
       BioCleanse diet/dosage recommendations
       in handout or ½ to 1 SVG/day for longer
       duration of time (1-3 months)
     – UltraPure Whey protein: 1 SVG/day
     – Occassional (rare) use:
               Captomer (Th) 1 capsule daily

12/9/2010
 Detoxification (Heavy Metals)
     – Possible dysbiosis treatment, intestinal
       reforestation and intestinal repair (ParaBiotic Plus,
       Florastor, ProFlora Plus caps, Intestinal Repair
       Complex)
     – Encourage exercise, pure water to hydration,
       adequate sleep, blood sugar balance through
       regular balanced (40/30/30), organic food based
       meals and stress reduction (prayer, meditation,
       Heart Math (www.heartmath.com), etc.)



12/9/2010
                Fibromyalgia
   R/O conditions such as: acidosis (urine/saliva
    pH), allergies, blood sugar dysregulation,
    electrolyte imbalance (serum, calf cramp
    challenge testing), EFA deficiencies, infection
    (approx. 50% or our patients show + to CMV)




12/9/2010
                Fibromyalgia
   Most common Rx‟d supplements:
    – Rx: Super FMS         (1-2 per meal)
    – Rx: PainX (2-3 BID to TID w/o food)
    – Rx: UltraMuscleEze (1/2 to 1 teaspoon twice
      daily)
    – Rx: BioInflammatory Functional Food (1 SVG/day)
         and encourage a zone balanced diet

    – Rx: OsteoGeneis ES (1-2 per meal) (if serum
      calcium less than 9.0, and calf cramp test less
      than 200 (goal 200-240 with no cramp)
    – Rx: EPA/DHA (2-3 twice daily with food)


12/9/2010
                   GERD
 R/O: hypo/hyperchlorhydria, Helicobacter
  pylori, food allergy
 If acids aggravate: Avoid (vineger, caffeine
  (coffee, chocolate, colas, black teas),
  tomatoes, citrus, alcohol, spicy foods, high fat
  foods)
 If acids ameliorate: Encourage
   – apple cider vinegar (1 tsp in glass of water
      with meals) to aide digestion

12/9/2010
                       GERD
   Rx:
   Gastric Repair Complex (chew or swallow) 2
    tablets with meals and before bed
   Intestinal Repair Complex 1 tsp BID to TID
   ParaBiotic Plus (if + H. pylori) 2-3 TID for 1
    month followed by:
   Florastor (Biocodex) 2 BID for 2-4 weeks
   ProFlora Plus caps 3 BID for 1 month
   Mastic Gum caps 1-2 per meal (if + H. pylori)

12/9/2010
                Headaches
   Diet: Hypoallergenic, zone balanced
   Exercise: 3-5 x/week, combination
    cardio/weights
   Rx‟s:
   Muscle Tension:
   UltraMuscleEze (1 tsp BID) or Tri Mag (1 BID
    with meals, according to bowel tolerence)
   OsteoGenesis ES (2 TID with meals)

12/9/2010
                  Headaches
   Migraine/vascular:
   MigraClear (1 TID)
   PainX (2 TID)
   OxyATP (1 TID)
   EPA/DHA (2-3 BID)
   Sinus Headache:
   BioAllergy Plus (2 QID between meals and before
    bed)
   PainX (2 TID)
   NAC (MM) (1-2 BID between meals)
   Euphorbium (Heel) or QC (Th) nasal spray
   Nasal rinse with ProFlora Plus caps

12/9/2010
             Heart Disorders
   Cardiac Arrythmia:
   Ultra CoQ10 100mg (1 BID with meals)
   UltraMuscleEze (1 tsp BID)
   Taurine (MM) (1-2 BID)
   Vitamin E 400 (1-2 QD with a meal)
   OxyATP (mitochodrial support) (1 BID with
    meals)


12/9/2010
             Heart Disorders
   Mitral Valve Prolapse:
   TriMag (1 per meal)
   Hypertension:
   Garlic 7000 (1 TID with meals)
   TriMag (1 TID with meals according to bowel
    tolerance)
   OsteoGenesis ES (2 TID with meals
   Carditone (Ayush) (2 BID)

12/9/2010
            Immune Enhancement
   Diet: Low in sugar, hypoallergenic, zone balanced
   Exercise: 3-5 x/week. Combination cardio/weights
   Stress reduction: set goals, prioritize, prayer,
    meditation, good sleep and eating habits, work on
    communication skills, organize
   Possible Rx‟s:
   Lipopure Melatonin oral spray (enhancement of
    thymus & sleep cycle)
     – 1-4 sprays before bed nightly


12/9/2010
            Immune Enhancement
   MycoPotent Immune Complex (20-30 gtts QD)
   Immune Balancing Complex (2 caps BID)
   Currently sick?:
   BioPotent C (2 TID or 1 tsp BID)
   PhytoImmune (3-4 TID) viral
   ParaBiotic Plus (2-3 TID) bacterial/fungal



12/9/2010
    Menopause/Perimenopause
   Zone balanced hypoallergenic diet
   Cardiovascular protection:
     – Ultra CoQ10 100 1 QD, OxyATP 1 QD, Vitamin E
       400 1 QD with meals
   Bone loss protection:
     – OsteoGenesis or OsteoGenesis ES
   Labs: Bone Loss Resorption (urine), DEXA scan
   Natural HRT:
   Lipopure Progesterone 15-30 gtts BID,
   BioIsoflavone 1 BID - TID or BioFem HRT 1 BID -
    TID
   Lab: Estronex (urine), salivary or serum Est/Progest
    and FSH
12/9/2010
      Osteopenia/Osteoporosis
   Labs: Bone Resorption (urine), Bone density (Dexa Scan)
   Weight bearing exercise
   HRT (if indicated: low or menopausal)
     – Lipopure Progesterone 15-30 gtts BID (osteoblast
       enhancement)
     – BioIsoflavone 1-2 BID (osteoblast enhancement,
       osteoclast inhibition)
   Soluble minerals and bone specific collagen for
    remineralization/remodeling of bone matrix
     – OsteoGenesis 2-3 TID
   UltraGest (if low stomach acid) 1-2 TID mid to end of meals
   MetabolX Functional Food (if overweight or needs help in
    improving protein intake, insulin/cortisol balance)
    12/9/2010
                Premenstrual Syndrome
 Diet:
 Zone Balanced, hypoallergenic, low in sugar, caffeine
 Evaluate hormone status: (often a progesterone deficiency)
 Lipopure Progesterone 15 gtts BID days 11 - 25.
  Depending on the severity of the PMS, I may have patient
  start earlier than day 11.
 BioFem PMS caps: 2 caps TID (days 10 to 3)
 Ultra B Complex 1-2 BID (coenzyme form for greater
  biological activity)
 TriMag 1-2 BID
 MetabolX Functional Food 1 SVG/day

    12/9/2010
            Prostate Disorders
 PSA laboratory testing. Blood draw before
  digital exam
 Physical exam of gland
 Benign:
 Rx: BioInflammatory Functional Food for 2-3
  weeks to detox and determine any possible
  food intolerences


12/9/2010
            Prostate Disorders
 Rx: BioProstate 1-3 BID
 Rx: EPA/DHA 2-3 BID
 Rx: DIM PRO PLUS (FIT) 1 BID -TID
 Malignant: Above recommendation as well as:
   – Proteolytic enzymes: BioPan or Vegizyme,
     Immune enhancers: MycoPotent Immune
     Complex and Immune Balancing Complex
   – Pulsed antioxidants (if on chemotx or radiotx
     treatment) OxyATP, BioPotent C
   – Anti-metastatic agents: Fractionated Pectin (Th)



12/9/2010
             Case
            Histories
12/9/2010
                Janet – CFS
     (Courtesy of Eleanor Barrager, DNFS, PGDD, Dip Ed)


 37 yo female; 1/2 pack per day smoker
 CC:CFS Duration: 5years
 Hx of moderate depression; Paxil for 5 months -
  no effect, d/c by pt.
 Sx: no energy, sleep disruption, awakes tired, poor
  memory, stiffness in joints, HAs with blurry
  vision during PMS, day and night sweats,
  intermittent nausea and vomiting off and on past 5
  yrs

12/9/2010
              Janet - CFS

 Major stressors in last five years: 2 children,
  breast feed both for at least 6 months, Mom &
  Dad both passed away, 20 year old son
  incarcerated and dishonorable discharge from
  military, parents dog died.
 Activity level: prepare food for self and family;
  care for 1 yo, 4 yo and 5yo children full-time;

 12/9/2010
            Janet - CFS

 No Hx of previous illnesses or
  hospitalizations except for 3 live births;
 Uses no-scent hair spray with no ill effects
 Household cleaners and air-freshners not
  well tolerated - Headaches,  brain fog, and
   fatigue
 No current medications, no supplements
 Hx of anemia after each child birth

12/9/2010
                    Janet - CFS

   Diet 24 hr recall (No food cravings)
    – B/F , coffee with sugar and milk
    – Lunch: white bread with ham or beef, cheddar cheese,
      occasionally tuna and potato chips, glass of milk; coffee
      with sugar/milk
    – Canned vegetables: greens beans or carrots, potato, rice or
      pasta, with beef chicken or pork; coffee with sugar and
      milk;
    – No food cravings; snacks diet coke; little water; no regular
      consumption of fruit/veggies

    12/9/2010
             Janet - CFS

 Sleep 6-8 hours; does not remember
  dreams; complains of night sweats;
 Energy level: 1-2 (VAS 1-10)
 Initial visit: patient appeared tired with dark
  circles under eyes; physical exam: WNL
  except for dry skin; B/P 110/70 and HR:84
  and regular. Wt:170 Ht:67.5”
 Initial SOS Score: 156

12/9/2010
                Xenobiotic Detoxification

                                              PHASE II
             PHASE I                          Conjugation
             Cyt.P450                         reactions
             oxidation                       *sulfation
                                             *glucuronidation
             reduction
                                             *glutathione
Nonpolar     hydrolysis     Intermediary       conjugation         Conjugated
Xenobiotic                   Metabolite      *acetylation          Metabolite
                             More polar      *amino acid           Polar
                          More water-soluble conjugation           Water-soluble
                                              (glycine, taurine,
                                             glutamine, etc)
                                             *methylation
                                                                  Excretion
                                 Excretion
                                                             Serum-kidneys-urine
                             in some instances
                                                                or Bile-faeces
                   Janet - CFS
   Intervention:
     – BioCleanse Functional Food: 1 scoop bid
     – BioCleanse Detox Caps: 2 bid with above
     – OxyATP: 1 bid with B/F & Lunch
     – UltraGenesis with iron: one with each meal
     – D/c activities that exacerbate fatigue
     – Reduce cigarettes to six or less per day
     – Increase intake of fresh fruit/vegetables and
       water

     12/9/2010
             Janet - CFS

               ROV: 3 weeks
 Feeling much better, less issues with fatigue;
 Sleeping better at night, less night sweats,
  daytime sweating has resolved;
 Headaches reduced in frequency and severity;
 Decreased # of cigarettes and requested help
  with quitting;

 12/9/2010
                 Janet - CFS

ROV: 3 weeks
   Increase BioCleanse Functional Food to 2 scoops bid
   Con‟t BioCleanse Detox caps at 2 bid
   Increase OxyATP support to 2 bid
   UltraGenesis with iron: one with each meal
   Commence quit smoking “goop” - solid extracts
    Eleutherococcus:Glycyrrhiza, 1:1; patient instructed
    to dip toothpick into goop and use in place of
    cigarettes.

    12/9/2010
            Janet - CFS
ROV 6 weeks
 Smoking cessation program successful;
 Fatigue considerably reduced
 Energy level: 5-6 (VAS 1-10)
 ENT and eye symptoms reduced by 50%+
 GI symptoms reduced, improved appetite
 50% + reduction in arthralgia/myalgia
 Less brain fog
12/9/2010
            Janet – CFS SOS scores
     35
     30
     25
     20
     15
     10
       5
       0
            EENT    GI   S/S    M/S Enrg M/M       Slp

                   Baseline    3 weeks   6 weeks
12/9/2010
     Lan – Fibromyalgia, MCTD
 Age: 51 y.o. female
 CC: Fibromyalgia (by referral from PCP), Mixed
  Connective Tissue Disease (possible Sjogrens or
  Lupus)
 Duration: 10 years
 Hx: Symptoms started in 1993 when dx with
  EBV. Hasn‟t been the same since then. Dx
  Fibromyalgia 1996. Dx. MCTD 1998. Started
  with fatigue in 1993. Stressful year. Working part
  time only (court clerk). Setting up parents 50th
  wedding anniversary
12/9/2010
     Sx: deep muscle aches (flu like), joint pain –
      comes in „waves‟. Dx EBV months later in same
      year. Anemia. Dx sleep apnea 1997 – uses
      CPAP. Helps sleep and slightly helps pain.
      Headaches from hunger. Photophobia, PAT,
      flushing hot flashes, chest pain, IBS, bloating,
      belching, dermatitis, exhaustion, back pain,
      butterfly rash. Water retention. Limbs feel like
      100 lbs.
     Activity level: moderate. Walk, stretch, nordic
      track 20-40 min. 3-4x/wk.
     pHx: tonsillitis 1957
     Medications:      Nadalol for PAT, Amitryptilene
      for Fibromyalgia, Prozac for stress.
12/9/2010
     Diet: B- Oatmeal, raisins, milk       Snack –
      apple, chocolate graham cracker w/peanut
      butter. L- lean meat, starch, fruit, veg.
      Snack- froz yogurt, popcorn, sweets. D-
      meat, veggies, grains. Drinks 8 glasses of
      water per day. 1 glass of milk per day.
     Sleep: Barely enough. Uses CPAP. 10PM
      to 7:15AM. Wakes tired.



12/9/2010
 Initial visit: 65 inches, 152 lbs. HEENT- nl, BP-
  108/70, pulse 78, RR nl. Skin – slt. mild Flush over
  nose/cheeks. Non-pitting edema mild lower
  extremities.
 Tender points 9/18. Dysbiosis questionaire score 377.
 Review lab hx: Sed rate range 63 (recent) to 124.
  Borderline to frank iron def. Anemia. Elevated
  gamma fraction (serum protein electrophoresis),
  hyperlipidemia (Cholesterol 240-270, Triglycerides
  160-180, LDL 156-182, HDL 50-58), T4 4.8-5.3.
  CRP nl at 0.7. Calcium 8.7 (ideal 9.2-10), Sodium 136
  (ideal 140-142)

 12/9/2010
   Intervention: Anti-inflammatory tx with
    Concentrated Ginger extract. Immune support
    with MycoPotent Immune Complex.
    Connective tissue support with ArthroGenX.
    Dysbiosis tx with ParaBiotic Plus and ProFlora
    Plus. Taurine/K/Mg formula for Cardiac
    support.



12/9/2010
            ROV – 1 months
     Fatigue up/down overall some
      improvement. Energy was 2-3 (0-10) now 5.
     Joint pain/deep muscle aches. Waves of
      pain – much less
     Edema- no change yet




12/9/2010
            ROV – 2 months
 Jt/Muscle pain – con‟t to improve now 4 (0-10, 10
  worst) was 8-9. Feeling hopeful. Decided to add
  massage therapy. Dreaming. Dreams more vivid.
  Reduced Amitryptilene by ½.
 Relates hx of Raynauds disease. Complaint of hands
  going to sleep when lying down. Has lost 15 lbs on
  Weight Watchers program.
 Walking 2-5x/wk.
 Exam: tender pts. 2-4/18 (2 mod. 2 slt), extremities –
  no edema, nl circulation.

12/9/2010
       Tx: Add MSM, CMO to tx. Finish
        dysbiosis tx (within next 2-4 weeks)

     ROV 4months
     Leg aches stopped 1 wk ago. 1st time in
      ages! Hands – numbness reducing. Sleep –
      improved. Con‟t with massage tx.



12/9/2010
            ROV – 4 months
 MVA days after last appt. While stopped rear-
  ended by truck and pushed into truck in front of
  her. Suffered Whiplash. No fractures.
  Developed neck/upper/lower back pain.
  Massage 2x/wk. Leg pain returned – slt.
  Overall not as bad as before. Recovering
  quickly from injury.
 Exam: tender pts 4/18. C2-3 R. Sublux


12/9/2010
                      .
    A/P: adjusted neck to correct
     sublux.Recommended „Ma Roller” for
     paraspinal muscle relaxation. Supplemental
     tx: no Δ.
    ROV – 5 months
    Fatigue, aches, pains, crumby feeling-all
     improved. Complaint of vaginal dryness.
    O: deffered
    A/P: Rx: EPA/DHA, BioIsoflavone, Vit E

12/9/2010
            ROV – 7 months
 Recent GI Sx. Diarrhea, bloating, gas, nausea.
  Fatigue worse since GI upset.
 Aches/pains – much less. Knees, back, jts.-
  much better. Gets tired from standing. Tired
  around 11 AM, feel hot during sleep, throws
  feet out of covers, must open windows, hot
  weather not well tolerated.
 Exam: BP 92/58
 A/P: added Sulpher homeopathic and Intestinal
  Repair Complex.
12/9/2010
            ROV- 8 months
 Great response to homeopathic sulpher and
  Intestinal Repair Complex. Energy up,
  strength up, able to stand longer without
  fatigue. Feels like “life going through her
  blood”. Diarrhea, nausea- gone. Gas reduced.
 Exam: 4/18 tender pts. All mild.
 Tx: Immune regulation tx begun using Immune
  Balancing Complex for T1/T2 cell regulation,
  for underlying stable autoimmune disorder.

12/9/2010
                ROV – 16 months
 8 months since last appt. Some recent flairs of
  symptoms. Stress high – son out of work living with
  her, 3 grandchildren. Extra activities. PCP referring
  over for Fibromyalgia, but Sx of autoimmune disorder
  predominate.
 Pain feet/legs, hips – achy. Difficulty standing beyond
  1 hour. Fell 3 times in last month. Dizzy, lightheaded,
  sugar cravings. No menses for last 4 months. Dx of
  diverticutitis. Tx with ABO then fiber. Doing fine
  now. Recent Sed rate 50, Na level 135. Ferritin 12
  (low iron reserves). Cholesterol 262. Deep fatigue has
  come back. Occ. Slurring speech. MRI – nl.
    12/9/2010
                ROV – 16 months
   Tx: disc. BioIsoflavone and move to Rx
    TriEst/Prog. Start anti-inflammatory
    ArthroGenX (Curcumin, ginger, boswellia,
    CMO, GS,CS,MSM, B3a), Con‟t on EPA/DHA,
    Immune Balancing Complex. Add ferritin. Add
    Arnica homeopathic. Patient wants to work on
    elevated lipids. Add BioLipotrol (inositol
    hexaniacinate, guggal, etc). Work on zone
    balancing meals

    12/9/2010
            ROV- 19 months
 Feeling much improved. Pain, inflammation
  down. Energy up. More active. Needs less
  sleep. Feel like I have a life again. Intestines –
  remain good.
 Labs: ferritin 22 (10-291)
 Exam: BP 120/78. P 68 R. HEENT nl, lungs
  clear, abd nl. Tender pts. 2-4/18
 A/P: run allergy testing. Lan thinks certain
  foods may trigger aggravation.
12/9/2010
                ROV – 20 months
 Allergy report – Reactions to beef, cane sugar,
  celery, corn, white potato.
 Feeling great! Supplements working well. Has been
  on Elimination diet pending allergy results. Fatigue
  – paces herself. Doing well. Intestines – doing well.
  All Sx clear except fatigue
 Recent labs: Chol 202, LDL 126, HDL 56, Tri 102,
  Sed rate 30, Ferritin 40, Na 140, K 4.0, CRP < 0.2.



    12/9/2010
 A/P: autoimmune disorder (MCTD) with
  fibromyalgia like symptoms.
 Implement allergy diet.
 Zone balance meals
 Con‟t on: Natural Rx HRT, ArthroGenX,
  BioLipotrol, EPA/DHA, Immune Balancing
  Complex, ferritin formula.
 Add: anti-inflammatory analgesic with
  homeopathic base- PainX (incl. Low potency
  arnica) to replace Arnica pellets.

 12/9/2010
                    Current
   Lan continues to do well. Following allergy
    elimination diet. On supplements as prescribed.
    To date her PCP and rheumatologist are not sure
    her exact Dx (MCTD, Lupus, Sjogren‟s). Lan
    does have evidence of mild dryness (mouth,
    eyes), but labs are neg. for Sjogren‟s.
    Diet/supplements have helped relieve dryness
    substantially.


    12/9/2010
                Cheryl – FMS
    (Courtesy of Eleanor Barrager, DNFS, PGDD, Dip Ed)

 52 yo female;
 CC: Fibromyalgia        Duration: 3years
 Hx of ongoing mild fatigue
 Sx: seasonal allergic rhinitis symptoms, low energy,
  poor sleep awakes often due to pain, cognitive
  dysfunction with short term memory loss and
  reduced comprehension, stiffness in neck, shoulder,
  hip and knee joints, constipation alternating with
  occasional diarrhea, occasional indigestion, ongoing
  flatulence and straining to eliminate stools, dry skin,
  intolerance to alcohol preservatives and processed
  foods.
 12/9/2010
             Cheryl - FMS

 Major stressors in last few years: son and
  daughter away at college, older daughter with
  grandson, works for ENT specialist as office
  manager, some financial issues.
 Activity level: low level of exercise with
  occasional moderate walking on weekends at
  mall; no weight resistance or aerobic activity.

 12/9/2010
              Cheryl - FMS
 Hyperlipidemia with elevated total cholesterol,
  depressed HDL, elevated LDL and elevated
  triglycerides;
 Abnormal GTT with elevated 2hr glucose and
  insulin;
 Food allergies: almonds, wheat, egg, milk,
  peanuts, and rye.
 MCS to household cleaners and perfume, fertilizer
  odors:  brain fog, and  fatigue

12/9/2010
                 Cheryl - FMS

   Diet 24 hr recall (CHO food cravings)
    – B/F Kashi cereal with milk and a cup of coffee
    – Lunch: wheat bread with cold cuts, coffee with milk, cup
      of vegetable soup (canned) or fruit
    – Chicken or meat with potato, rice or pasta and one
      green or yellow/orange vegetable;
    – Drinks diet coke and chew sugarless gum; poor water
      intake; usually one canned soup or stock on most days
      used in cooking.
    – Eats out 2-3 times a week – Mexican, TeriYaki or
      Chinese.

    12/9/2010
              Cheryl - FMS

   Sleep 7-9 hours - interrupted; awakes unrefreshed;
   Energy level: 4 (VAS 1-10)
   Initial visit: patient presented with dark circles
    under eyes; physical exam: WNL except for dry
    skin and dandruff; B/P 163/83 and HR:76 and
    regular. Wt:169 Ht: 64”
   RJL: 43% body fat, low intracellular water, high
    extracellular water, phase angle 5.6
   Initial SOS Score: 108

12/9/2010
                Cheryl - FMS
    Intervention:
      – BioInflammatory Functional Food: 1 scoop bid
        for 4 days followed by 2 scoops bid for next 19
        days
      – Anti-Inflammatory Diet but also avoiding
        known food allergens, MSG, artificial
        sweeteners, all refined carbohydrates, and high
        fat foods
      – EPA/DHA: 2 capsules bid with food on non-fish
        days
      – Regular exercise – moderate walking program
    12/9/2010
             Cheryl - FMS

                ROV: 19 days
 Feeling much better, less issues with fatigue
  and myalgia pain; energy level: 5-6
 More restful sleep at night;
 Blood pressure 148/80 (previously163/83)
 Weight: 162
 Less irritability
 Able to walk on treadmill at 3mph at 3.5%
  incline for 15 minutes daily
 12/9/2010
            Cheryl - FMS

ROV:19 days
 UltraMuscleEze: one level teaspoon bid
 BioCleanse Detox capsules: 3 bid
 Continue EPA/DHA: 2 bid with food
 ProFlora Plus: first thing in the morning and
  just before bed with a little soy yogurt


12/9/2010
              Cheryl - FMS
ROV 6 weeks
 Fatigue and pain considerably reduced
 Energy level: 7 (VAS 1-10)
 Weight: 159
 Cognitive function much improved
 GI symptoms totally resolved
 No dark circles under eyes
 MCS much improved able to tolerate limited
  exposures with no symptoms

12/9/2010
            Cheryl - FMS
  ROV 6 weeks
   Intestinal Repair Complex powder – 1
  tspn bid in water or permitted dilute
  juice
  Continue UltraMuscleEze powder: one
  level teaspoon bid
   Food reintroduction/challenges to
  identify “trigger foods”
   UltraGenesis w/o Iron – 2 bid with
  food
12/9/2010
                  Cheryl - FMS
ROV 9 weeks
 Feeling very well, good energy: 8
 Walking 20 minutes 5/7 at 3.5 mph at 4.5% incline
 Weight: 156    B/P:140/78
 Started on maintenance program:
   – 4-day rotation diet,
   – UltraGenesis w/o iron 2 bid,
   – EPA/DHA 2 bid on non-fish days,
   – UltraMuscleEze powder – 1 tspn per day,
   – ProFlora Plus probiotics

 12/9/2010
        Loretta – Migraines, MCS
 Loretta - Migraines, MCS and Food Allergies
 56 y.o. female
 CC: headaches, allergies (food and chemical,
  hormones, digestive and joint pain
 Hx: chemical sensitivity started in 1976. Moved
  to Colorado 1975 lived in moldy basement
  apartment and exposed to 2nd hand smoke.


12/9/2010
                    Loretta
   Hx: HA‟s “all her life”, but esp. worse since
    son born in 1976. Had Bell‟s Palsy just
    prior to delivery. Tx with ABOs. Difficult
    delivery, rectal fissures. Tx with steroids,
    surgical repair. Developed yeast infection.
    For several years yeast infections. Always
    treated topical only.

12/9/2010
                  Loretta
 Hx: Infection as a child treated for 3 mo.
  Straight with ABO. Since 1980‟s sees
  allergist for shots and elimination diet,
  challenges, testing and symptomatic Tx.
 Sx: HA‟s daily at least 2 hours duration.
  Migraines – pulsing, beating. N/V.
  Irregular frequency, can be from 50 per
  month to 1 per month.
12/9/2010
 Sx: Tried elimination diet with bowel cleansing
  enema – white mucus in stool
 Reacts to: “all chemicals”, perfumes, tobacco,
  phenol, formaldehyde, garlic, dates, wheat,
  potatoes, baking powder. Allergies keep
  changing.
 Major Stressors: marriage, health, work as a
  CPA.
 Activity level: mild to moderate walking 30
  minutes daily.

 12/9/2010
 PHx: Hysterectomy 1978, Hemorrhoid and
  polyp surgery 1983, Kidney stones 1991.
 Medications: Imitrex PRN.
 Nutritionals (Self Rx‟d): St. John‟s Wort, Mg,
  Chromium, CoQ10, Acidophilus, CaGS
  osteo/arthritis formula, barley green, flax oil,
  psyllium fiber.
 Diet: Beans, non gluten whole grains, rice,
  salad or steamed vegetables, several fruits and
  some nuts. Essentially vegan.

 12/9/2010
 Energy level (1-10, 10 highest): 2-3
 Initial visit: Ht. 62 inches, 170 lbs. HEENT nl,
  PERRLA, Lungs Clear to AP, BP 130/78, pulse 76 R.
  Heart RRR, Essentially normal exam with the
  exception of fatigued look, allergic eye lid creases,
  increased abdominal gas/bloating on auscultation,
  neck, low back and hip pain on ROM (stiffness and
  decreased ROM)
 Dysbiosis questionnaire score 159. Had discontinued
  Premarin on her own and switched to Black Cohosh
  and then to only Natural Progesterone topical.


    12/9/2010
 A/P: Migraines, food/airborne sensitivity,
  probable dysbiotic bowel with probably
  increased mucosal permeability. Surgical
  Menopause, possible early DJD. Needs Bone
  loss protection program.
 Rx:
 Lab: Digestive/Microbial stool analysis.
 Tx: MigraClear caps, Quercetin, Bioflavonoids,
  BioAllergy Plus caps, topical progesterone.

 12/9/2010
 ROV (1 mo): Laboratory results: NL
  digestion/ absorption, Microbiology: Ø
  acidophilus, 2+ Non lactose fermenting E. Coli
  (poss. Pathogen), Ø yeast, 5.9 pH (6-7.2).
  NLF E. Coli sensitive to tannins.
 Added Tx: antimicrobial tannin combination,
  ProFora Plus and Florastor.



12/9/2010
                ROV – 2 mo.
 Recent UTI. Saw local MD. Tx w/ABO q 5 days.
  Continued on Tannins and ProFlora Plus and Florastor
 Migraines – less frequent. 10-12 days apart now.
  Intensity still bad. N/V. Top of head HA‟s less
  severe. Has feeling of hope now.
 Counseled on marriage relationship with Loretta and
  spouse. Stress issues.
 Rx: began desensitization homeopathic allergy drops
  (household dust/molds, chemicals (formaldehyde).
  Based on allergists findings. Urine/Saliva pH testing.


 12/9/2010
             ROV – 6 months later
 Intestinal dysbiosis – corrected
 Migraines- less frequent, less severe, recovery faster.
  No Migraines in the last 2 months! Using only ¼ to ½
  MD Rx medication PRN. No regular HA‟s
 Eating more fish and veggies, less CHOs. Has lost 31
  lbs in last 6 mo. Exercises 2-3 hours per day doing
  landscaping.
 Notices gets migraine when pH drops too acid (5.6-
  5.8 range saliva). Less food and chemical
  sensitivities.


 12/9/2010
            ROV – 6 months later
                continued
 Intestinal gas/bloating subsiding.
 Tarred a roof – got HA, but no migraine.
 Energy 7-8.
 Excited about life.
 Working things out with spouse.
  Communicating now.


12/9/2010
           ROV – 12 months/current
    Had a few 10 day cycles of HAs (1 q 10 days) but
     since last visit- none. (last visit ~ 3 mo earlier)
    Bowels regular (BM 1-3 per day)
    Weight – 134 (Ht.62 inches) lost 36 lbs total
    Eating large variety of foods with no reactions.
    Chemicals – still sensitive to cigarette smoke
    Arthritis: no joint pains since pH in 6.2-6-4 range.
    “Exciting changes in their marriage”


    12/9/2010
            ROV - Current
 Some hot flashes
 Tx: New:
 TriEstrogen phytobotanical formula,
 Lipopure Progesterone
 BioAlkalizer powder.
 OsteoGenesis E. S. caps. Con‟t:
 MigraClear caps.
 Desensitizing oral drops

12/9/2010
                 Multiple Pathology Case
                           CASE
             (Courtesy of Kathleen Matteson, ARNP, ND)


       June 2001- Jan 2003 (treatment time frame)
       76 y.o. white female
       CC:
         – CFIDS X‟s 15 years
         – FMS x‟s 12 years
         – Hyperlipidemia x‟s 15 years
         – Hypothyroidism
         – Sleep disturbance x‟s 2 years
         – IBS x‟s 10 years

12/9/2010
                  CFIDS
   +EBV: IgG 4.74 high, EBNA >5.00 high
   +Chlamydia pneumoniae: IgG 512 (normal <
    32), IgA 256 (normal < 16)
   - Lyme titer, - HSV 6, - CMV
   Rx: Targeted transfer factors (EBV,
    C.pneumoniae): 1 cap daily x 30 days
    followed by pulse therapy monthly at 5
    consecutive days each month.
   All symptoms have resolved

12/9/2010
              Hypothyroidism
                      June 2001



 Rx: Armour thyroid 45 mg daily
 Successfully raised free T4 to 1.1, free T3 to
  300 (230-420), TSH normal.




12/9/2010
        Irritable Bowel Syndrome
                 June 2001

 Diarrhea predominant symptom
 Allergy test: positive IgG1, IgG4 to
  Wheat (4+)
 Rx: BioCleanse Functional Food
  powder: 2 scoops with bulk fiber 2
  scoops daily. Disc. Wheat products
 Symptoms resolved

12/9/2010
              Hyperlipidemia
                    January 2002

    Had been on Zocor 40 mg QD from
    cardiologist for past 10 years that kept
    lipids @:
     – Cholesterol (total): 232 high
     – Triglycerides: 107
     – LDL: 140 high
     – HDL: 32


12/9/2010
                     Hyperlipidemia
                     January 2002 continued
     Rx: discontinued Zocor
     Begin:
            – Natural lipid lowering combination formula
              BioLipotrol:
                  2 caps TID
            – EPA/DHA
                2 perles BID

               Also was able to increase exercise to 30
                 mins/day because chronic fatigue was better

12/9/2010
               Hyperlipidemia
                  March/April 2002


   After 3-4 months:
     – Cholesterol (total): 206 (nl < 200)
     – Triglycerides: 79
     – LDL: 113
     – HDL: 77




12/9/2010
    Fibromyalgia w/sleep disturbance
                January 2003
 Klonipin nightly has helped slightly, but
  patient does not want to continue to take
 Rx: discontinue regular use of Klonipin
 Begin: Super FMS (Mg glycinate, malic
  acid, MSM) 2 caps TID
 TriMagnesium (citrate, malate, glycinate
  form): 1 cap TID
 Response: not completely pain free
 12/9/2010
    Fibromyalgia w/sleep disturbance
                       February 2003
   Rx: Anti-inflammatory pain relief combination
    formula: PainX (WBE, DLPA, Bromelain, Ginger,
    Curcumin, Boswellin, Guggal, proteolytic enzymes,
    homeopathic base)
 2 caps at bedtime every night
 Response: patient now is pain free and not
  waking @ night. Not taking Klonipin. First
  night on above formula patient slept 7 hours
  uninterrupted for the first time in 2-3 years.
 12/9/2010
12/9/2010
            Justice Arlin Adams of Pennsylvania, in a
            speech to a college, ended with the last
            words of the educator Horace Mann.


               “Be ashamed to
            die until you have
            won some victory for
            humanity”

12/9/2010
            Let us go
              and do
            likewise!
12/9/2010
  “Beloved,     I pray that
     you may prosper in all
        things and be in
      health, just as your
         soul prospers.”
             3John:2
12/9/2010

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:35
posted:12/9/2010
language:English
pages:196
Description: Allergy Questionaire Release Form document sample