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Novel Approaches to Managing Pain and Inflammation

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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 – PowerPoint PPT presentation

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Title: Novel Approaches to Managing Pain and Inflammation


1
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

2
Recommending a Strategy
  • Ideas for Today and Tomorrow
  • In this presentation I will present natural
    nutritional alternatives for your patients with
    pain and inflammation

3
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

4
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.

5
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

6
A Partial List of Inflammatory Mediators
  • Classical complement pathway
  • Alternate complement pathway
  • Tromboxane
  • Prostaglandin E2 (PGE2)
  • NF Kappa B
  • Arachidonic acid
  • Platelet Activating Factor (PAF)
  • Substance P
  • C-Reactive Protein
  • Super oxide radical
  • Hydrogen peroxide
  • Lipid peroxide
  • 5 - Lipoxygenase
  • Leukotriene B(4)
  • Cyclooxygenase
  • Inflammatory cytokines -
  • Tumor Necrosis Factor alpha (TNF alpha)
  • Interleukins (IL -6 and IL 1(B))

7
A Partial List of Conditions Related to Chronic
Inflammation
  • Cancer
  • Heart Attack - coronary atherosclerosis
  • Alzheimers 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

8
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.

9
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

10
Available Nutritional OptionsOverview
  • Licorice root
  • Nettles (Urtica dioica)
  • Ginkgo biloba
  • Capsaisin topical
  • Commiphora mukul
  • Rosemary
  • Botanicals
  • Turmeric (Curcumin)
  • Boswellia serrata
  • Ginger
  • Feverfew
  • White Willow Bark

11
Available Nutritional OptionsOverview
  • DL Phenylalanine
  • Bioflavonoids
  • Proteolytic Enzymes
  • Bromelain
  • Papain
  • Trypsin
  • a Chymotrypsin
  • Homeopathics
  • Arnica
  • Bryonia
  • Rhus toxicondendron

12
Available Nutritional Options
  • Connective Tissue Repair Factors
  • Glucosamine Sulfate (GS)
  • Chondroitin Sulfate (CS)
  • Methylsulfonylmethane (MSM)
  • Immune Modulators
  • Cetyl Myristoleate

13
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 51260-3, 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

14
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

15
Lifestyle Modification - Diet
  • Eat More foods with a low glycemic index and high
    in monounsaturated fats
  • Salmon other fish
  • Oatmeal whole grains
  • Olives olive oil
  • Nuts/Seeds and their oils
  • Fresh fruits vegetables
  • Avocado
  • Eat Less or Avoid foods with a high glycemic
    index, high in saturated fats and high in
    arachidonic acid (AA)
  • Fatty cuts of meat
  • Organ meats - high in AA
  • Egg yolks - high in AA
  • Pasta, juices, sugar, white rice, white bread -
    high glycemic index

16
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.
    198613(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
    Mar134(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
    23274(17)11660-6.

17
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 3121217-23, 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.

18
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

19
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

20
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, 198192
  • Zinc was shown to significantly reduce arthritic
    symptoms in psoriatic arthritis patients in a
    double-blind crossover study
  • Br J Dermatol 103411-15, 1980

21
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 (plt0.01).
  • Agents Actions 6454,1976
  • Werbach, M. Nutritional Influences on Illness 2nd
    Ed. Tarzana, CA. Third Line Press,1993

22
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

23
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 (18)167-9, 1995.

24
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

25
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 59597-601.

26
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.

27
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.

28
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 2037-43, 1997

29
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

30
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.

31
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.

32
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
    11508-11, 1997.

33
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.

34
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.

35
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 4652-6,
    1996
  • Werbach M, Murray M. Botanical Influences on
    Illness A Sourcebook of Clinical Research.
    Third Line Press, Tarzana, CA. 2000

36
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 5644-47, 1990.
  • Flynn R, Roest M. Your Guide To Standardized
    Herbal Products. One World Press, 1995.

37
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

38
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 ginkgoflavonglycoside
    s and 6 terpenes.

39
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.

40
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 77135-40, 1994.
  • Deal CL et al. Treatment of arthritis with
    topical capsaicin a double-blind trial. Clin
    Ther 13(3)383-95, 1991.

41
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 (2001401388-93)

42
Natural Therapeutics-Botanicals/White Willow
  • WWB has been used therapeutically for 2000 years.
  • WWB is
  • Anti-inflammatory
  • Antipyretic
  • Analgesic
  • Hemostatic
  • Antithelmintic

43
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.

44
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.

45
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.

46
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.

47
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 Jul27(7)
  • 1455-7

48
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 2311(8)985-9.

49
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 Mar7(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 Feb59(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 Jun60(6)929-31.

50
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

51
Natural Therapeutics Botanicals/Rosmarinus
officinalis
  • Reported uses cont
  • 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.

52
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.

53
Natural Therapeutics- Nutritional Options/DLPA
  • DL-Phenylalanine (DLPA) may have analgesic
    properties thought to be through DPAs blockage
    of enkephalin degradation by the enzyme
    carboxypeptidase A.
  • DLPA should be avoided by those with PKU and
    those taking MAO inhibitors.

54
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

55
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.

56
Natural Therapeutics-Proteolytic Enzymes
  • Bomelain contains
  • 4cysteine proteases
  • Acid phosphatase
  • Peroxidase
  • Amylase
  • Cellulase
  • Stem proteases ananain and comosain
  • Bromelains uses
  • Speeds healing time
  • Pain reduction (post surgery and athletic
    injuries)

57
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

58
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.

59
Natural Therapeutics-Proteolytic Enzymes
  • Bromelain
  • Kumakura S, Yamashita M, Tsurufuji S. Effects of
    bromelain on kaolin-induced inflammation in rats.
    Eur J Pharmacol. 1988 150295-301.
  • Masson M. Bromelain in blunt injuries of the
    locomotor system. A study of observed
    applications in general practice. Article in
    German. Fortschr Med. 1995 113303-306.
  • 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
    1632568-2575.
  • PDR for Nutritional Supplements, 1st Ed. Medical
    Economics/Thomson Healthcare. 2001.

60
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.

61
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.

62
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

63
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

64
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.

65
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.

66
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.

67
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.

68
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.

69
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.

70
Natural Therapeutics - Methylsulfonylmethane
  • Muravev 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.

71
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.

72
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.

73
Boswellia, Ginger,
Nettles, Turmeric, Feverfew
Nettles
Ginger
Licorice
74
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

75
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)

76
Summary - Natural Inhibitors of Inflammatory
Mediators
  • Botanicals
  • Boswellia serrata
  • 5 - lipoxygenase
  • Leukotrienes
  • Classical complement pathway
  • Alternate complement pathway

77
Summary - Natural Inhibitors of Inflammatory
Mediators
  • Botanicals
  • Ginger
  • 5 - lipoxygenase
  • Leukotrienes
  • Thromboxane
  • PGE2
  • Platelet aggregation

78
Summary - Natural Inhibitors of Inflammatory
Mediators
  • Botanicals
  • Feverfew
  • Phospholipase A2 - inhibiting at initiation step
    of
  • Prostaglandins
  • Thromboxanes
  • Leukotrienes

79
Summary - Natural Inhibitors of Inflammatory
Mediators
  • Botanicals
  • Licorice
  • Phospholipase A2 - inhibiting at the initiation
    step of
  • Prostaglandins (PGE2)
  • ROS
  • Inhibits degradation of cortisol

80
Summary - Natural Inhibitors of Inflammatory
Mediators
  • Botanicals
  • Nettles
  • NF Kappa B
  • Arachidonic Acid
  • Leukotriene B4
  • Cyclooxygenase

81
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)

82
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

83
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

84
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

85
Laboratories Providing Suggested Tests
  • Some labs to contact for information on available
    screening tests
  • Doctors 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

86
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

87
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

88
Additional References Novel Approaches to
Managing Pain and Inflammation
  • Brod SA. Unregulated inflammation shortens human
    functional longevity. Inflamm Res 2000
    Nov49(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 May52(5)465-77.
  • Kremer JM. n-3 fatty acid supplements in
    rheumatoid arthritis. Am J Clin Nutr 2000
    Jan71(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 Jun23(6)733-8.

89
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 10103(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
    Mar50(3)397-408.

90
Novel Approaches to Managing Pain and
InflammationConclusion
  • 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_at_bio-genesis.com
  • dwoodnd_at_trinityclinic.com

91
Stuff to Take Home
92
Clinical Protocols
93
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

94
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)

95
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.

96
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)

97
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.

98
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

99
Arthritis
  • R/O DJD vs. RA
  • exam
  • family history
  • Zone Balanced Diet

100
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)

101
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.

102
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)

103
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)

104
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)

105
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.

106
CFIDS
  • Clean up the diet (Zone balanced whole foods) and
    establish a routine
  • often patient eats on the run. Eats fast food.
    Doesnt 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)

107
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
  • Rxs
  • 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)

108
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)

109
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

110
Colon Disorders (IBS, Colitis, Crohns)
  • Labs
  • Organix (urine) or Digestive/Microbiol/Parasite
    (stool)
  • Allergy (IgG, or Elimination/Challenge)
  • Hemocult (if DMSP above not done)
  • Colonoscopy (if indicated)

111
Colon Disorders (IBS, Colitis, Crohns
  • 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)

112
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 Rxs
  • Metal Cleanse oral drops ½ tsp BID
  • Toxi HMF 2 - 3 capsules BID without food

113
Detoxification (Heavy Metals)
  • Rxs 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

114
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.)

115
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)

116
Fibromyalgia
  • Most common Rxd 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)

117
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

118
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)

119
Headaches
  • Diet Hypoallergenic, zone balanced
  • Exercise 3-5 x/week, combination cardio/weights
  • Rxs
  • Muscle Tension
  • UltraMuscleEze (1 tsp BID) or Tri Mag (1 BID with
    meals, according to bowel tolerence)
  • OsteoGenesis ES (2 TID with meals)

120
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

121
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)

122
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)

123
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 Rxs
  • Lipopure Melatonin oral spray (enhancement of
    thym
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