Canadian Homeopathic Conference – Toronto 2016

Best Medicine: In’s and Out’s of Integrative Medicine

CAM

Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine

CAM

NCCAM - the thoughtful "combining of mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness."

CAM

“The practice of medicine that reaffirms the importance of the relationship between practitioner and 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”

Health

Health is not simply the absence of disease. Health is best defined as a positive state of dynamic balance in which a person functions well and interacts with their environment smoothly and efficiently.

Health is an investment, not an expense. The investment in time, effort, and money must be realized every single day.

Nomenclature

A Paradigm Shift: Traditional/conventional medicine may soon be considered "alternative“. Complementary medicine - once regarded as “traditional” - is often applied in "integrative“ settings and even more often provides the basis for first line therapy (versus drugs or surgical intervention).

The Future

The Future of Healthcare

- Integrative: best evidence-based practices combined

- Personalized: “know patient right down to their genes”

- Mind-Body Medicine- Lifestyle

Tumour Model

Surgery

Radiation

Chemotherapy

Physician

Tumour

Patient

Conventional medicine

- Tumour is to be removed and destroyed

- Doctor is in control. Patient has little say, participation in decision making, or role to play in their healing

Tumour Model

Immune Enhancement

Prayer

Surgery

Chemotherapy

Radiation

Vitamins &

Supplements

Exercise

Stress Reduction

Avoidance of Toxins

Emotional Support

Healthful Diet

SELF

MeditationParticipant

Physician & other

Practitioners

T

Integrative Approach

- Tumour removal and destruction is likely part of the process

- Other healing modalities are integrated

- There is a formed relationship between the patient and a support network of practitioners

Who Seeks Care at P3 HealthPreventive Health / Executive Health / Concierge Care

Chronic Illness

P3 Health

Personalized:

A model that reflects the customization of healthcare, with medical decisions, practices and products tailored to the individual patient.

The Promise of Personalized: - Cost-effective- Improved health outcomes for individuals and

populations

Personalized

Personalized

P3 Health

Participatory:

A method by which networked patients shift from being passengers to drivers of their health, and in which providers encourage and value them as full partners.

P3 Health

Preventive:

A movement that focuses on protecting, promoting and maintaining health, as well as forestalling the development of disease, disability and death.

Preventive

An ounce is worth a pound

- Cardiovascular risk assessment- Reduction in Cancer risk - Surveillance- Anti-aging

Life Extension

Squaring the Curve:

Represents the ideal of postponing the decline in health associated with age so that people enjoy a good quality of life and die as healthy as possible as late as possible - interventions should aim to improve both quality and length of life, not merely to prolong life at all costs

100%

Vitality

QOL

Wellness

AGE yrs

25 50 75 100 125

Inflammation

Oxidation

A.G.E.s (Sugar)

Life Extension

Squaring the Curve:

- Telomeres: - Oxidative Stress:- AGE’s:- Inflammation:

Chronic Illness

Managing Chronicity's

- Lyme disease- CFS / FMS / IBS- Post Concussive Syndrome- Chronic Pain- Peri/Post Menopause- Andropause- Mental Health- Etc.

Essentials for an Integrative Practice

Collaboration

EMR

Electronic Medical Record

- digital version of a paper chart that contains all of a patient's medicalhistory from one practice

- Keeps everyone on the “same page” literally and figuratively

- Customizable IAP’s and forms - Observational clinical data to

determine efficacy of elements of IAP

I.A.P

Integrative Action Plan

- Summary of prescribed treatments - Helps guide the patients

expectations- Acts as an internal billing travel slip- Establishes compliance- Specifies duration of treatment and

intended follow up

MOA

Mechanism of Action

- Homeopathy does not seem to be compatible with the current mechanistic-molecular paradigmatic model

- The mechanism of action of HM is still unexplained but appears to have a regulatory effect and possesses an unknown structure (if any)

Obstacle to Cure

Functional laboratory assessment

- Helps assess impact of the IAP including the homeopathic remedy

- Homeopathic prescription wont have a lasting effect without solving obstacles to cure; often nutritional / micronutrient

Diagnostics

Bioimpedance

- Helps to evaluate the physical health of a patient

- Able to discern ICM/ECM, lean vs fat tissue, water compartmentalization, and phase angel vs age/gender matched

- Helps to decide potency

Diagnostics

Bio Terrain

- Helps to evaluate the health of a patient and how prone they are to disease

- Helps to decide potency - Helps motivate the patient

Diagnostics

Intestinal Biome

- Provides insight into gut flora by identifying commensal bacteria

- Identification of parasites- Biomarkers indicating levels of

digestive and absorptive functions, as well as potential issues with gut inflammation and immunology

Diagnostics

Micronutrient Testing

- Provides individuals status of Antioxidants, B Vitamins, Digestive Support, Amino Acids, Essential Fatty Acids, Heavy Metals, and Minerals

Diagnostics

Inflammatory Cytokines

- Provides insight into potential causes of chronic inflammation including autoimmune disorders, viral infection, allergy and asthma, and cardiac disorders.

- IL-2, IL-6, IL-8, IL-10, IFN-y, TNF-a

Diagnostics

Food Sensitivities

- While not life-threatening, some foods can bring on a wide range of unpleasant symptoms such as respiratory or gastrointestinal disorders, migraines, headaches or dermatological problems such as eczema and prove as significant obstacle to cure

Diagnostics

Toxins

- According to the U.S. Department of Health and Human Services Agency for Toxic Substances and Disease Registry (ATSDR), Environmental factors contribute to more than 25% of all disease.

Diagnostics

Genomics

- Disease specific risksCardioGenomicsDetoxiGenomicsNeuroGenomicsOsteoGenomicsHormone Genomics

- “Lifestyle” GenomicsAthletic performance / Exercise prescriptionNutrigenomics

- Pharmaco-Genomics- Cancer Genomics

Germ-line (patient’s original)Somatic (cancer tissue / cell sample)

Whole Chromosome Changes Insertion / Deletion Change = InDel

VariabilitySingle letter = SNP (Single

Nucelotide Polymorphism)

eg. Centre vs Center 15%

Whole word change = Allele

eg. Centre vs Middle 5%

Paragraph change = CNV (Copy Number Variation)

75%

Variants

Detecting Variants

- Rapid advance in sequencing technology

- NGS = NEXT GENERATION SEQUENCING

- Faster, cheaper, more accurate- Now “era of $1000 genome”- 13 yrs / $2.7 billion to complete

human genome project

Co$t

Age at onset of probable Alzheimer’s disease

Apo-E Allele

Apo-E Genotyping

- Strong associations with CVD (Cardiovascular Disease) and AD (Alzheimer’s Disease)

- E 2 (lower risk), E3 (“normal”), E4 (higher risk)

Methylation

Methylation Pathway

- Detoxification- Immunity- Maintains integrity of DNA- Energy Production- Etc.

Diagnostics

Carotid Doppler

- Beyond Framingham Risk - Emerging CV Risk Factors

(genomic, phenotypic)- Non-invasive, rapid, vascular

imaging

Diagnostics

Telomere Testing

- Telomere length and Cardiovascular disease

- Cancer, Vascular dementia- Degenerative conditions- Diabetes- Anxiety / High stress- General Chronic disease

- Changes of gene expression in response to experience, environmental exposures, behaviours

- Epigenetic changes are heritable!

Epigenetics

MBSR

Mindfulness Based Stress Reduction

- Dr. J. Kabat-Zinn “Mindfulness is paying attention in a particular way: on purpose, in the present moment, and non-judgmentally… to facilitate change in conditioned patterns of thought, behaviour”

MBSR

AWARENESS

THOUGHTS

AWARENESS

EMOTIONS

5 SENSES

PERCEPTIONS

PAIN/SUFFERING

INTUITION

BODY/SOMA

MBSR

1998 2003 2007 2009 2011 20121992

Improves

chronic pain,

symptoms in

fibromyalgia

Improves skin

clearing iin

psoriasis and

symptoms in

IBS

Reduces

stress,

anxiety &

depression

Improves

symptoms in

heart disease,

immune function

in healthy, and

HIV

Reduces BP

Improves

glycemic

control in

Diabetes

Reduces

levels of

cortisol &

stress

Leads to

epigenetic

changes in

stress

genes

Changes

brain

structure /

volume

Reduces

brain

atrophy with

age

Lengthens

telomeres,

aids in

weight loss

Improves

working

memory

MBSR - Research

Heart Math

Biofeedback

- Monitoring your emotional and physical health. Helping you improve it. - 50% drop in fatigue- 46% drop in anxiety- 60% drop in depression- 24% improvement in the ability to

focus- 25% improvement in listening ability- 30% improvement in sleep

Marketing

External Marketing

- Conventional Television- Social Media / Digital Media- Public Education: Similisan

documentary- Packages that incorporate multiple

practitioners

Social Media

Documentary

D.A.R.I

Diabetes and Related Illness

- 4 month program to help those suffering from diabetes, heart disease, stroke and cancer, and those at risk of developing Metabolic Syndrome

- A “Quarterback” guides patient through all assessment and services

D.A.R.I

Diabetes & Related Illnesses

Fully Integrated Program:• Consultation MD + CAM professional• Health coach, Holistic Nutritionist• Testing• Integrative Action Plan

• Lifestyle – diet, fitness, MBSR / H.M.• Supplements• Medications if necessary

FYB

Feel Your Best

Experiential 3 hrs• “Bootcamp”• Yoga• Meditation• Teaching Kitchen demonstration /

nutritional meal• Interactive discussion

Case Analysis

Case of a 23 y.o. Female Athlete

• Ms. C.S. 23 yo athlete presented to clinic

in fall 2015

• Sought care of Sam Gibbs (Osteopathic

Manual Practitioner) for

post-concussion syndrome

• National ski team until age 13, but 3

concussions, third “career ending”

Case Analysis

Case of a 23 y.o. Female Athlete

• Now competitive cyclist trying for national

team

• July 2015 – hit by car while cycling.

CONCUSSION AGAIN

• Ongoing symptoms: headaches,

imbalance / disequilibrium, fatigue

• Addt’l symptoms noted, prompts referral

by family MD to Dr. Cook

Case Analysis

Case of a 23 y.o. Female Athlete

• Many years of variably orange

discolouration of skin esp. palms

• Exercise tolerance dropping

• Fatigue even before concussion

• Referrals to multiple specialists

(dermatologist, endocrinologist,

internist…)

B.I.A.

Lab work up

“OHIP” bloodwork

HS-CRP 0.4TSH 1.22 with normal free hormonesTTG Ab negativeGliadin IgA sl. ElevationHgb 117 (115 – 155)MCV 102 (80 – 99)Reticulocytes 21 (20 – 85)Ferritin 81Vitamin D 88Vitamin B12 732!RBC Folate >3000Carotene 5.16 (0.19 – 1.58)

Special Labs

- Genomics (nutritional, methylation, detox)

- Functional / Orthomolecular (NutrEval)

- Microbiome Analysis

Genomics

Genomics

Genomics

Functional

Functional

Functional

Functional

Functional

Functional

Functional

Gut Biome

Gut Biome

Gut Biome

DIAGNOSES:1. POST-CONCUSSION SYNDROME2. NUTRITIONAL DEFICIENCIES

• Esp. B Vitamins due to methylation genomics (despite high serum B12)

• Anti-oxidant deficiencies (exacerbated by GSTM CNV and slow Cyp 1a2)

• Magnesium deficiency• Lactase deficient (genomic confirmation)

3. INADEQUATE MICROBIOME BIODIVERSITY / DYSBIOSIS4. MALABSORPTION (Contributing to #2)5. I.B.S.6. Stress!

Case Analysis

1. Referral Dr. Dan Demian / Sam Gibbs• Neurorehabilitation / vestibular re-training / concussion recovery• Manual therapies2. Stress Management• MBSR vs HeartMath3. Diet• PALEO – dairy free, grain free4. Custom Supplementation• Vitamins, antioxidants, botanicals• IVMT with glutathione, B12 injection then S.L. MethylCobalamin• High dose Probiotics (VSL #3 + Bio K)5. Homeopathic Helleborus Niger (more striking than any of her other symptoms, was that she was so much more dull and slow when compared to before the concussions)

I.A.P