14 – Integrative Medicine – Flashcards

- The practice of medicine that reaffirms the importance of the relationship between the practitioner and the patient, - focuses on the whole person, - is informed by evidence, - and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.

- Medical care that views physical and mental and spiritual aspects of life as closely interconnected and equally important approaches to treatment.

- the art and science of healing that addresses care of the whole person: body, mind, and spirit.

- Patient and practitioner are partners in the healing process. - All factors that influence health, wellness, and disease are taken into consideration, including mind, spirit, and community, as well as the body. - Appropriate use of both conventional and alternative methods facilitates the body's innate healing response. - Effective interventions that are natural and less invasive should be used whenever possible. - Integrative medicine neither rejects conventional medicine nor accepts alternative therapies uncritically. - Good medicine is based in good science. - Alongside tx, the broader concepts of health promotion and the prevention of illness are paramount. - Practitioners should exemplify its principles and commit themselves to self-exploration and self-development.

- most is musculoskeletal (back + neck pain, joint pain, arthritis...)

- Seeking something missing from conventional medicine - patient-focused, hands on approach - Modalities and methods not offered conventionally - Reluctance to engage "allopathic medicine"/Opposed to "drug therapy" - Want an approach that does not focus on pharmacology and surgery - "Integrative holistic physicians characteristically view symptoms in the context of an underlying problem, attempting to treat the cause, rather than to suppress the symptoms alone."

- Herbal medicine - Nutritional medicine - Functional medicine - Manual medicine → Osteopathic, chiropractic, naturopathic - Body work → Massage, Rolfing, Alexander, Craniosacral therapy, Reike,... - Acupuncture/Traditional Chinese Medicine - Ayurvedic Medicine - Homeopathy - Meditation/guided imagery - Counseling - Dietary, Lifestyle - Yoga, Tai Chi, Chi Kung

- Herbal and nutritional medicines are very popular - Brief overview of several that I recommend for many patients with irritable bowel syndrome (IBS) - Peppermint - Fennel - Probiotics - Saccharomyces boulardii

- Safe (GRAS by FDA) - Oil obtained from steam distillation of above ground parts - Volatile oils → Menthol - *antispasmodic* and more - Flavonoids → Bile stimulant, antiviral, antioxidant, antiallergic - Phenolic acids (rosmarinic acid) → Antioxidant

- Performance-enhancing →Aroma may improve cognition, attention and alertness & Improve tactile performance - Topical analgesic effects → Especially thermally sensitive nerves → Nociceptors and A delta fibers - Wide range of antibacterial and antifungal activities (-static and -cidal) - Also, antiparasistic and antiviral - Antitussive

- Antispasmodic effect on smooth mm → Probably due to calcium channel blockade - Improve rhythmic peristaltic activity - Relieves intestinal spasm - Increased bile secretion - Antiulcerogenic effect (antioxidant-mediated?)

- Acid reflex (don't want to relax SM in sphincter, make reflux worse) - Alternatives: Licorice root (DGL if long term) Chamomile tea

- Mild licorice flavor - GRAS - Side effects: extremely rare allergy

- Antispasmodic effects in GI tract → Anticholinergic and calcium blocking effects - Shown to be effective with infantile colic - IBS products available with enteric coated peppermint oil and fennel, often with ginger as a third ingredient

- Live microorganisms, which, when administered in adequate amounts, confer a health benefit on the host - Similar to microorganisms found in healthy human gut - Normal human digestive tract contains about 400 types of probiotic bacteria, especially strains of: *Lactobacillus & Bifidobacterium* - Number of bacteria = 10 x number of human cells in the body - Present in certain fermented foods, especially yogurt

- complex sugars used as fuel by bacteria to stimulate healthy microorganisms and inhibit pathogens

Consensus emerged on probiotics as treatment for: - Diarrhea - Irritable bowel syndrome - Prevent and manage atopic dermatitis/eczema in children - Prevent UTI - Particularly helpful for antibiotic-associated diarrhea - C. difficile colitis - Irritable bowel syndrome Research is still underway regarding inflammation, immune regulation, cardiovascular effects, and other areas of interest such as ulcerative colitis

- A non-pathogenic yeast strain - The only well-known probiotic yeast at this time - Helps prevent diarrhea associated with antibiotic use, tube feedings, and infectious diarrhea (especially of childhood)

- Helpful in prevention and treatment of C. difficile-associated diarrhea → Produces a protein that both breaks down and inhibits the binding of C. difficile-produced toxin A to the brush border - Many effects - many mechanisms - Postulated that it may be a *transient* colonizer in the gut microflora but still exerts a significant probiotic effect by enhancing growth of native healthy bacteria and inhibiting pathogenic or over-growing organisms - One popular brand is Florastor

- Dietary changes → Lactose-free diet helps some people significantly → Gluten-free diet helps others, not all → Whole-food, plant-based diet usually helps, if transition is done gradually (avoid "the explosion") - Regular exercise - Meditation - Stress reduction/counseling - Acupuncture/TCM - Functional medicine approach

- One definition (there are many): "Medical practice or treatments that focus on optimal functioning of the body and its organs, usually involving systems of holistic or alternative medicine." - The focus of Functional Medicine is on systems, often starting with the GI system

- *Remove* → Eliminate things in our body contributing to poor health → Certain foods, pesticides, food additives, unwanted bacteria, and parasites - *Reinnoculation* → Probiotics and other friendly flora - *Replace* → Supplements to support function - *Repair* → Nutritional support to regenerate and heal the body

- imbalance of gut flora → Many factors: antibiotics, diet, stress, illness, other medications

- Inflammation of mucosa leads to hyperpermeability - Allows incompletely digested food, parasites, yeast/fungi, and harmful bacteria to permeate mucosal lining

- Leads to hyperactive immune system, allergic reactions, and *increased activity of the HPA (Hypothalamic-pituitary-adrenal) axis* = stressed system with many manifestations

Elimination diet (Remove) - Temporarily limit diet to low allergen, easily digested diet, often with rice-based food supplements with added nutritional factors (anti-inflammatory) - Temporarily eliminate alcohol and caffeine Complete diagnostic stool assay (Remove) - Look for pathogens as well as measuring metabolites of digestion and populations of various bacteria in the gut - Treat pathogens, identify deficiencies of beneficial bacteria, identify digestive problems related to function of stomach, pancreas, gall bladder, and look for patterns of unhealthy bacterial or fungal overgrowth - Rifaximin and other non-absorbable antibiotics are useful for treating small bowel bacterial overgrowth - Antifungals for yeast overgrowth

- Probiotics → Various mixes and strengths - S. boulardii - Fermented foods?

- Supplements to help digestive deficiencies → HCl → Digestive enzymes → Bile salts → Minerals can help - Zinc can be lost in diarrhea. Replacement can help digestive enzyme function → Glutamine for enterocytes - Healthy fiber, "prebiotics"

- Supplements to help improve function - Glutamine for cells of intestinal lining - Fish oil to decrease inflammation - Detoxification→ Supplements to augment hepatic phase I and phase II (conjugation) detoxification - Maximize function and balance of HPA → Adrenal support with herbal medicines, such as licorice root, Siberian ginseng (eleuthero), rhodiola, ashwaganda - Sometimes use salivary testing every six hours for 24 hours to measure cortisol and DHEA levels in a circadian fashion - Ratios give an indication of adrenal stress/HPA activity

- Enteric coated peppermint oil capsules with fennel (+/- ginger) - Gentle daily aerobic exercise - OMT to address viscerosomatic and somatovisceral reflexes → Thoracic, thoracolumbar, and upper cervical areas - Stress reduction - Meditation → Evidence in particular for Mindfulness Meditation; Study showed 38% reduction in symptoms - TCM and Ayervedic medicine would have their own approaches

- Human body is a miniature version of the larger, surrounding universe - Harmony between to opposing, complementary forces, yin and yang supports health → Disease results from imbalance between these two - Five elements symbolically represent all phenomena in general and organ systems in particular → Fire, metal, wood, earth, and water

- Qi (chi) is a vital energy that flows through the body maintaining health → It flows primarily along certain pathways known as meridians - These meridians correspond with functional organ systems - Acupuncture points are located along these pathways and are used to influence the function (chi) of different organs - Twelve principle meridians and eight "extraordinary" meridians

- Five element theory and internal organ systems → Generating and controlling cycles → Yin and yang organs - These correspond with specific meridians Example: Heart meridian goes out UE, up to meet spleen meridian and connects down to small intestine meridian - Five elements correspond to emotions as well as organ systems

- History - Pulses → Three positions → Two levels -deep and superficial → Correspond with twelve principle meridians - Looking at tongue and eye

- Evidence in medical literature supporting use for → Pain → Osteoarthritis → Nausea and vomiting - Courses for physicians to learn acupuncture = medical acupuncture (some states require licensure)

- Chi kung (Qi gong) - Tai chi chuan - Hsing I chuan

Consider referring to a TCM practitioner when you identify a patient with: - On-going problem that is not easily treated/resolved - After ruling out major problems such as CA, aneurysm... - OK to use with these problems is already treated/identified - Patient is willing and able to go - Cost can be an issue - often not covered by insurance

Definition: The treatment of disease by minute doses of natural substances that in full strength in a healthy person would produce symptoms of disease Treat "Like with like" - Example: Drinking too much coffee = insomnia and agitation - Homeopathic remedy made with extremely diluted solution of coffee is used to treat these symptoms - While not the same philosophy as vaccines there is some overlap

Samuel Hahnemann, 1755-1843 - German physician who decried the harsh medical practice of his day (Blood-letting, purging, tinctures of arsenic, opium); Searched for a safer medical treatment - Experimented by giving smaller and smaller doses of medicine - Smaller doses seemed safer and had more effect - "Like causes like", studied many, many substances - Documented his findings in books that were to become the foundation of homeopathic medicine

- Individuals consist of spiritual and material aspects "Vital dynamis" → Disease caused by deterioration of an immaterial vital principal in individuals → Remedies trigger a cure through bringing the body back into a state for healthy reception of this vital force - Serially diluting and succussing substances potentized the remedy with an immaterial power

- Start with a mother tincture (plant or other natural substance) - Diluted and succussed - Serial dilutions → Theoretically, the greater the dilution the greater the potency → Often added to a sugar pill base - Not much evidence supporting outcome - Architecture of water is an intriguing area of study - Used to treat symptoms and also constitutions = extensive history

- Mind-body medicine - Lifestyle - patient education and motivation → Healthy eating - plant-based whole food diet → Exercise therapy individualized for each pt - Massage, chiropractic, Rolfing, Alexander therapy - Ayurvedic medicine - traditional approach from India - Yoga

- Meditation practice - lots of research showing benefit with mindfulness meditation - Counseling