An Introduction to Integrative and Functional Medicine

? Vulvar Disorders ?

Rebecca A. Malamed M.D. Integrative and Functional Medicine

Pain Management

What is Integrative and Functional Medicine?

• Integrative medicine

– Healing- oriented medicine – Focus on therapeutic relationship– Whole person (body, mind, and spirit) – All appropriate therapies, both conventional and alternative

• Functional medicine– Dysfunctions of physiology and biochemistry – Chronic disease assessment, prevention and Rx

Differences in Diagnostic Approaches

• Conventional Medicine: – Disease/disorder based diagnosis – Vulvovaginitis, Vulvodynia, Lichens Scleroris, Lichen Planus,

Hyperplasia, Neoplasia – Search for “magic bullet” as Rx

• Integrative/Functional Medicine: – All symptoms in ANY system relevant – “Anything can cause anything” – Search for underlying function to Rx– Functional Medicine testing

Differences in Treatment Approach

• Conventional medicine– “Evidence-based” – Gold Standard: double-blind placebo-controlled– Pharmaceutical/intervention driven Rx

• Integrative/Functional medicine– Basic research-based– Gold Standard: Individual patient symptom resolution– Least harmful/synergistic Rx to allow body to heal

Your Genes on Twinkies

• Environment and Gene Expression account for almost all human disease (Epigenetics)

• Disease vs. Health is an expression of each patients:– Genetic predisposition: Cofactors, Detoxification,

Immunity– Physical Environment: Nutrition, toxins (heavy metals,

fungus, sucrose/fructose), sleep, exercise – Emotional milieu: Family, friends, mental health – Spiritual beliefs and practices

The 7 Organizing Systems Where Clinical Imbalances Develop

• Assimilation: Digestion, absorption, microbiota/gi, respiration

• Defense and Repair: Immune, inflammation, infection/microbiota

• Energy: Energy regulation, mitochondrial function

• Biotransformation and Elimination: Toxicity, detoxification

• Transport: Cardiovascular, lymphatic system

• Communication: Endocrine, neurotransmitters, immune messengers

• Structural Integrity: From subcellular membranes to musculoskeletal structure

Assimilation

• Complete and healthy absorption requires– Intact intestinal villi

• Food Sensitivities can damage and destroy intestinal villi – Mediated through IgA Immediate Type

Hypersensitivity Reactions

Destruction of Intestinal Villi in Celiac Disease

Assimilation

• Absorption– Increased intestinal permeability can lead to

symptoms or signs of ANY inflammatory condition locally or systemically

– Mediated through IgG delayed type hypersensitivity

Leaky Gut ProgressionINTACT PROTEINS

Assimilation

• Microbiome: 100 trillion bacteria– Skin, gut, mouth, vagina

• Local antimicrobial treatment not sufficient?– Healthy microbiome (balanced flora) – Dysbiosis (opportunistic species predominate)– Vulvar-vaginosis, vulvodynia and other vulvar

disorders may have abnormal GI flora as precursor

Defense and Repair

• Decreased Immunity– Host defense vs. virulence of organism– Vulvar-vaginosis, Vulvodynia

• Excessive Immunity = Inflammation– Food sensitivities (IgG, IgA), Toxins– Autoimmunity– Vulvodynia, Lichens Scleroris, Lichen Planus, Hyperplasia,

Neoplasia

Biotransformation and Elimination

• We are what we eat? Actually…

• Want cleanest in and dirtiest out

• Limit toxicity and need for detoxification

• Vulvovaginal disorders may be caused by an accumulation of inflammatory mediators locally and total body burden of toxins

Toxicity

• Natural: Plants and microbes

• Manmade: Chemical, heavy metals etc.- 60,000 to 80,000 in common use- $1.5 trillion in 2010 sales by Census Bureau- Backlog of 10,000 never tested by EPA- US largest manufacturing sector

The Liver Detox Pathways and Essential Nutrients

Diet recommendations

• Organic/Biodynamic• Non-GMO

- Corn, soybeans, canola, papaya, sugar beets

•Avoid processed food- Pesticides, dyes, additives

• Candida diet- Low glycemic, non-fermented (no alcohol, soy sauce)

• Cook and store food with stainless/glass

Elimination Diet for Food Sensitivities

•Most Common- Eggs, dairy, gluten, corn, soy

•Nightshades (Solanine)- Potatoes, eggplant, peppers , tomatoes

•Methylxanthines- Chocolate, coffee, caffeinated tea

•Any food cravings

Rx Toxins/Irritants

• Chlorine – Filtered water (drinking/bathing) – Organic cotton underwear

• Hygiene products – Organic tampons, non-toxic soaps etc.– Environmental working group (EWG)

• Heavy metals– Mercury: amalgams, predatory fish – Lead: solder in water pipes, paint, leaded gasoline– Aluminum: cookware, antiperspirant– Mineral Cosmetics, Gadolinium contrast dye

Natural Detoxification

• Sweating– Hot baths, saunas

(infrared), exercise

• Diet– STOP SUGAR– Dark leafy greens,

garlic, onions, cruciferous vegetables, seaweed

• Supplements- Glutathione, vitamin

E, glycine, taurine, NAC etc.

• Fiber- Organic oat bran,

charcoal, bentonite clay

• Deep Breathing- Exercise, meditation

Goals of Natural Antimicrobials, Immune Modulators and Detoxification

• Increase innate host resistance and immunity

• Downregulation of excessive inflammation

• Balancing of microbiome synergistically

• Prevention of microbial resistance

Natural Antimicrobials• Prebiotics/Probiotics

– Inulin, fermented vegetables– Multiple probiotic strains

• Coconut oil – (MCFA, Lauric acid, Caprylic acid)

• Essential oils– Tea Tree, Lavender, Oregano

• Herbs/Barks/Mushrooms – Pau D’Arco, Berberine, Sweet Wormwood, Reishi

Natural Anti-inflammatories

• Omega-3 & Omega-6 Essential Fatty Acids– Grass fed beef/lamb/dairy (omega-3)– Organic nuts and seeds (omega-6)– Fish oil (omega-3)– Blackcurrant seed oil (GLA,)– Sesame seed oil (omega-6)

• Antioxidants– Dark green leafy vegetables, cruciferous vegetables– Turmeric (curcumin), Red grapes (Resveratrol)

Summary

• Our genes + our environment = our health• “Anything can cause anything”• Goals: – Increase host immunity and defense– Decrease (modulate) inflammation appropriately

• Method:– Removing environmental stressors– Optimizing underlying biochemistry– Offer synergistic support of body systems

More Information• Related articles @ www.drrebecca.com

– Dysbiosis - a gut reaction – Food sensitivities and allergies– Sugar - not so sweet after all– Heavy metals– Detoxification - an essential process– Acute and chronic inflammation - more than just a pain– A balanced diet - why’s it so complicated?– Genetically modified food - what’s for dinner?– Probiotics in prebiotic– Dietary fiber - the lost nutrient

Rebecca A. Malamed MD10780 Santa Monica Blvd. #480, Los Angeles CA 90025

310-474-8111 / dr@drrebecca.com