Reporting for The Townsend Letter
John Parks Trowbridge M. D., FACAM
A Potpourri of the Day’s News
Radio icon Paul Harvey served as a link to both headlines and human interest stories for three generations ahead of the dot-com boom. Now, the public and physicians alike are bombarded by daily “nutrition newsletters,” each blaring the latest research … and often promoting “the most advanced products” for you to take best advantage of the newest knowledge.
In this setting, semi-annual meetings of ICIM – the International College of Integrative Medicine – offer a refreshing potpourri designed to inform and excite practitioners, giving pragmatic details on emerging treatment strategies that can be implemented in the coming days or weeks. Malcolm Sickels, M. D. (Ann Arbor, Michigan), skillfully assembled a panel of inspiring and practical speakers. [www.drsickels.com]
Improving Cancer Treatments
“Treating the Impossible,” the 54th Congress for ICIM, exceeded the expectations of the hundred-plus physicians, office staff, and medical students attending in Dearborn, Michigan. While conventional medical practitioners are slowly adopting “basics” such as LovazaÒ for cardiovascular “protection,” integrative physicians are embracing ever-more-aggressive life-style, diet, and nutritional programs to enhance the results available with standard chemotherapy and radiotherapy for malignancy. Diana Quinn, N. D. (Ann Arbor, Michigan), reviewed evidence-based studies on the “oncogenic terrain,” supporting the evaluation of systemic inflammation and reduction of nonspecific and immune-induced pathways in cancer patients. Control of metabolic syndrome and intestinal dysbiosis, along with coordinated anti-inflammatory nutrients and botanicals, have been shown to improve treatment response and survival and to reduce recurrence. [www.naturopathicwomenshealthcare.com]
Environmental Illness and Detoxification
Robin Bernhoft, M. D. (Ojai, California), himself a recovered “environmental illness” patient, reviewed the comprehensive diagnostic and treatment approach that has evolved for those presenting with complex EI complaints. Of interest are the studies confirming the role of toxic heavy metals in amplifying and perpetuating these EI syndromes, since numbers of treating physicians fail to appreciate this detoxification needed. Genetic susceptibility and modifiable environmental exposure interact, according to the Centers for Disease Control, in the production of “virtually all human diseases” [with the obvious exception of structural issues]. Common organic and inorganic toxins, including mycotoxins, play a pervasive (and often unsuspected) role in maintaining EI symptoms and inducing pathologic changes, especially neurologic, immunologic, endocrinologic, dermatologic, and psycho-emotional. Genomic studies are available now to help guide nutritional replacement, specifically to support detoxification pathways. [www.drbernhoft.com]
Autoimmunity and Gluten Intolerance
The several roles of digestive insufficiencies in the development of autoimmune syndromes were reviewed by Tom O’Bryan, D. C. (Encinitas, California). Clearly our degenerative diseases are the result of inflammatory processes, many of which interrelate with autoimmunity. “Stop throwing gasoline on the fire”: the gut-associated immune system and the neuro-endocrine network can be challenged across the intestinal lining by every bite of food. The interplay between genes and environmental triggers (accessing tissues through increased intestinal permeability) explains the progression of autoimmune disorders. Allergen-free diets alone are insufficient to “heal” such “leaky gut” permeability. Celiac disease is one of the most common disorders seen (and usually missed) in Western medical practice … often undiagnosed during early activation of the inflammatory cascades. Liver blood test abnormalities might be the only early indicators of atypical celiac disease. All patients with nonspecific liver histopathology normalize after one year on a strict gluten-free diet. [www.thedr.com]
Food sensitivity, through inflammation (“inflammaging”), stimulates the overexpression finally seen as autoimmune disease. Increased gut permeability is a persistent acute response (lasting for months), occuring within 36 hours of the tiniest gluten exposure that ignites the inflammatory cascade. Immunological markers relate to gut dysbiosis, to breakdown in gut epithelial integrity, to frank autoimmunity. Recent reports show a high prevalence of celiac disease in osteoporotic patients. All older patients finally diagnosed as sporadic inclusion body myositis – showing as myalgias and muscle atrophy, unresponsive to steroids – improve with avoidance of gluten. Anti-gliadin antibodies can cross-react with synapsin, which regulates neurotransmitter release and is found in most neurons of the central and peripheral nervous systems. Also present can be anti-ganglioside antibodies that attack myelin and axons, resulting in peripheral neuropathies … commonly found in celiac patients. Adverse cross-reactions to foods such as milk casein, rye, barley, maize, oats, American cheese, others (even coffee in some) can be seen in patients with anti-gliadin antibodies, resulting in broadly expressed neurologic, psychologic/psychiatric, and physical symptoms. Gluten appears to be a permanent intolerance, due to T-cell memory. The loss of intestinal barrier function, combined with genetic predisposition and environmental triggers, is fundamental in the development and perpetuation of long-presumed-untreatable degenerative and autoimmune diseases.
Infective Etiologies in Degenerative Diseases
In the treatment of “impossible problems,” Simon Yu, M.D. (St. Louis, Missouri), correlated classical and modern acupuncture “whole body” perspectives, with special emphasis on the contribution made to cancer promotion, neurologic problems, and autoimmune disorders by parasites, toxic heavy metals, dental pathologies, and unresolved emotional issues. As a general rule, all cancer patients have important dental problems that can be improved. Organ-related acupuncture meridians that “run through” various teeth often correlate the sites of root canals, crowns, large mercury amalgams, periodontitis, cavitations, galvanic currents, or other hidden dental problems with refractory illness in the related organ. In stubborn cancer and degenerative disease cases, empiric treatment with anti-parasite prescriptions and botanicals – along with other integrative modalities – has led to documented improvements in Acupuncture Meridian Assessment patterns. Sadly, stool analysis for parasites is not a reliable test, and many parasites are situated outside the gut. He sees many patients whose frustrating medical problems resolve partially or completely with treatment of parasites and/or dental pathology and toxic heavy metals. Parasites are deceptive, adaptive, and difficult to confirm and eradicate, especially with pets living in intimate contact in homes. Drugs, durations, and dosages for chronic/smoldering infections often vary from those generally promoted for acute infestations. Dr. Yu asks a provocative question: is Lyme disease actually a dental infection problem? [www.preventionandhealing.com]
Multiple Sclerosis and Venous Stenosis
David R. Hubbard, Jr., M. D. (San Diego, California), a neurologist with a personal family interest in “MS,” reviewed the controversial data and theories regarding how an alternative treatment can be stunningly successful for multiple sclerosis patients. The venous structures have been largely ignored, as medical training and practice focuses on the arterial system. Interventional radiologists routinely do vein valvuloplasty – such as for the internal jugular and the azygos – so assessment and treatment should be widely available. Dr. Hubbard maintains that “back pressure” in the internal jugular veins leads to hypoperfusion that distresses the oligodentrocytes, resulting in unwrapping of the myelin from the axons. As disintegration progresses, microglia (macrophages in brain) are activated to scavenge the myelin and cellular debris and to recruit assisting leukocytes into the brain parenchyma. Blood-flow drainage from the brain was delayed (obstructed) in MS patients; dilatation of the internal jugular veins returned the drainage pattern to normal. Chronic venous restriction appears to take years to produce symptomatic change, in marked contrast to arterial obstruction. The valve abnormality appears to be congenital in most “MS” patients – all such patients have “difficult veins” – but occult infection has not been excluded. [www.hubbardfoundation.org]
How could venous stenosis relate to the pathophysiology of MS? The “autoimmune theory” of MS has not been confirmed despite decades of investigation costing $40 billion. Could it be a result of impaired venous drainage? The resulting cellular “swamp” in the zone of oligodendrocyte/myelin degeneration diverts (through back-pressure, back-flow, or turbulent eddies?) even more blood flow away and stagnation further aggravates the inflammatory processes. Overseas, post-dilatation venous stents have been used much more than here; the jury is still out. Clinical improvement – in up to 35% of patients – appears to be much more available than through disease-modifying drugs. Other neurological conditions also might be amenable to improvement of venous drainage: Alzheimer’s, Parkinson’s, chronic Lyme Disease, perhaps some cases of migraine or chronic fatigue. Interestingly, patients with venous obstruction in Canada are allowed to be tested and treated … UNLESS they have MS, for which it is prohibited. A multi-center registry is overseen by the Hubbard Foundation, and Medicare approves payment in the United States. Fascinatingly, only 1 patient in 260 treated by Hubbard’s group has had a “relapse” over up to 18 months of follow-up, which likely was a new lesion appearing. This interventional radiologist treatment is very promising for a frustrating, debilitating disease.
Alzheimer’s as “Brain Diabetes”
Why would ICIM host a newborn intensive care specialist, Mary T. Newport, M. D. (Spring Hill, Florida)? You need to know: Alzheimer’s has been dubbed “Type 3 Diabetes,” that occurring in the brain. Her personal family need led to application of an intense physiology background to solving the problems of loss of insulin and neurons with insulin growth factor receptors, both early signs of developing AD. Alternative fuels – such as ketones – can support brain function when glucose uptake is impaired … a fact demonstrated in the mid-1960s. Ketones can provide up to two-thirds of fuel energy in the “starvation” brain. Carbohydrate restriction induces body ketone production (hydroxybutyrate and acetoacetate) within days, peaking in several weeks. The ketogenic diet and intake of medium chain fatty acids (absorbed directly into the portal vein, converted to ketone bodies in the liver) can bypass the usual glucose-insulin pathways. [www.coconutketones.com]
Interestingly, studies conducted over the past 100 years of the ketogenic diet (over 80% of calories from fats) have shown positive effects in epilepsy, Alzheimer’s, Parkinson’s, Lou Gehrig’s (ALS), traumatic brain injury and stroke, oxygen toxicity, glioblastoma, and weight loss. Up to 80% of cancers might respond as well, since their cells are unable to use ketone bodies for fuel. Medium chain triglycerides have been shown in recent years to produce AD improvements similar to the ketogenic diet. The main adverse side effect can be diarrhea with this “medical food,” Axona. Within days of starting her adult patient on simply MCT, his “lights came back on,” the facial tremor resolved, the visual disturbance resolved, his gait normalized, his memorial improved, the whole gamut of classical AD symptoms markedly improved.
Of interest, use of coconut oil/MCT oil produces peak ketone levels one-tenth of those with the ester Axona, one-fiftieth of those with diabetic ketoacidosis. Ketones appear to reduce the production of free radicals and to activate anti-inflammatory mechanisms. Brittle diabetics given MCT oil showed far less cognitive impairment after induced hypoglycemia. Herpes simplex I is more prevalent in beta-amyloid plaques in elderly brains, and the amyloid might serve as anti-infective. A new hypothesis proposes that nitrates and nitrites in foods produce insulin deficiency and resistance in the brain. Dietary nitrosamines might trigger viral multiplication in brain cells. Coconut oil fragments might be killing the herpesvirus. Antivirals such as acyclovir are being considered as well.
The Law … and More
The legal terrain for integrative medical practice was reviewed by Jaya Venkataramani, an associate attorney with our general counsel, Al Augustine (Chicago, Illinois). Recent legal issues include informed consent documents, record-keeping, email communications, and prescribing without an exam or without records. Board actions and malpractice cases involve each of these key areas, especially for unconventional practices. All diagnosis should be based on clinical judgment and not solely on non-standard test modalities. Always see the patient at the first visit and at least annually thereafter. Adopt an office policy regarding how email will be used in the practice. A specific informed consent for using emails should be used as well. All emails and other message notes should be filed in the medical record. Get this: requesting a photo ID to confirm the identity of a new patient should now be standard office procedure. When do you need legal representation: whenever “they” (whoever!) address you in any way – don’t talk to them until you have benefit of counsel. [A key benefit of ICIM membership is our innovative Physician’s Risk Analysis Program, overseen by our general counsel, long-experienced in Board and malpractice issues.]
A pragmatic review of office integrative approaches was offered by Richard Ng, M. D. (W. Bloomfield, Michigan), sharing “pearls” across the diagnosis and treatment spectrum. Of special interest were his nebulized inhalation of ultra-dilute Lugol’s iodine or dilute colloidal silver, to help with nasal congestion. Iodine deficiency is rampant, along with adrenal stress. Complications of sulfur and molybdenum insufficiency can impair the success of various treatment approaches. A few dozen slides shared his comprehensive “secrets” – especially for respiratory distresses – culled from years of family practice. [www.centerforholisticmedicine.com] Natalie Moulton-Levy, M. D. (Monroe, Michigan), stepped out of the traditional dermatology mode to share the use of herbals to reduce inflammation, modulate the immune response, and control infection. The real eye-opener was trying to figure out which system about which she was talking: digestive adequacy, leaky gut, liver detox, kidney excretion … all these are relevant in devising effective wholistic dermatology treatments!
Body energetics and structural discomforts blend gracefully in the field of neural therapy, so well presented by Gerald Harris, D. O. Autonomic nervous system distresses – usually felt as pain and limitation of function – can be relieved without drugs and without surgery. Neural therapy is an injection treatment that resolves interference fields and corrects the underlying ANS dysfunction, in up to 90% of pain patients. Exotic infections, occult interference fields, even cancer can interrupt treatment effectiveness. Injuries long forgotten or dismissed as “too inconsequential” are often the root of structural and interferential changes that make daily life stressed and uncomfortable. [www.neuraltherapytexas.com]
Senior ICIM members – Rick Linchitz, M. D., Rick Mason, D. O., Elizabeth Vaughn, M. D., and Marton Dayton, M. D., D. O. – took the lead in discussing aggressive evaluation and treatment advice and strategies to improve immune function in cancer patients, responding to audience questions. Lead-in small group seminars on a variety of topics shared details on popular subjects before the general sessions.
So … who is going to help you take care of patients on a daily basis, especially with intravenous treatments? We have “a solution” here as well: your trained infusion therapist! Lambert Titus Parker, M. D., ably assisted by his practice colleague, Patricia Nash, R. N., N. P., shared their perspectives with two dozen nurses and medical assistants. Introducing a major program revision developed at ICIM over the past several years, Dr. Parker emphasized that basic academic training of your patient care staff is at the heart of healing with care and caring. The value of “physician extenders” has long been recognized, and certification training will be desirable in the evolving regulatory environment. As sophisticated care delivery shifts more to the office setting, alert personnel can reduce the need to schedule more frequent physician visits. Alternating with the “introductory” program will be one featuring “advanced” concepts, for those clinical assistants who need an ever-broader grasp of the contribution they can make to patient care. [www.infaneeta.com]
Sounds like you would like to join us in the future? Mark your calendar for next spring, at the end of March: we’d love to introduce you to our world!
As our hero Paul Harvey closed each broadcast: “Good day!”
Dr. Trowbridge is a past president of ICIM and coauthor of Bantam Books’ classic reference The Yeast Syndrome, now available in multiple ebook formats.
Fact-checking and other questions: Dr. Trowbridge, firstname.lastname@example.org, 1-800-FIX-PAIN