Introduction, thank you for having me here Here to talk about integrative pediatrics for your child, and what things you can do at home for your child to help treat him/her naturally
Elisa H. Song, MD
Shepherd diagnosed with JIA at age 3 now is 5 Susannah Meadows writes the Newly Releas ed column for The Times.
four marvels powder: quercetin, berberine, and achyranthine
As a board-certified pediatrician, also board-certified in holistic medicine, I integrate conventional western or allopathic pediatrics with various complementary and alternative healing modalities to tailor care for each individual child. I do believe that exploring all the various healthcare options that are available to us can best help our children thrive to their fullest potentials
Complementary and Alternative Medicine & Integrative Medicine Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products not presently considered to be part of conventional medicine. Although some scientific evidence exists regarding some CAM therapies, for most, questions of the safety and efficacy of these therapies in treating disease still exist. Integrative medicine combines mainstream medical therapies and CAM therapies that have been evaluated by clinical studies. For more information, visit: http://nccam.nih.gov/health/whatiscam/. This website is appropriate for both health care providers and patients to find information about diseases, supplements, and ongoing research.
Major Classes of CAM Alternative medical systems, including homeopathic, naturopathic, and traditional Chinese and Ayurvedic treatments; Ayurvedic treatments come from India and include diet, meditation, exercise, herbs, massage, exposure to sunlight, and controlled breathing. Mind-body interventions that seek to enhance the mind’s capacity to affect bodily function and symptoms, including hypnosis and meditation Biologically-based therapies, including dietary supplements such as herbs, foods, vitamins, and other natural substances Manipulative and body-based methods, including chiropractice, osteopathy, and massage Energy therapies, including biofield therapy and bioelectromagnetic therapy This presentation will focus entirely on biologically-based therapies.
This is a list of the various complementary and alternative, or CAM, modalities that I integrate into my practice But, there are many more modalities that I encourage you to also explore, including: Ayurveda (Ayurvedic medicine), biofeedback, chiropractic medicine, Hypnosis/guided imagery, massage therapy, meditation, osteopathic manipulative therapy (OMT), Qi gong (internal and external Qigong), reflexology, Reiki, spiritual healing, and Tai Chi
Included multi vit
Functional medicine is a way of looking at how the genetic predisposition each individual is born with, interacts with everything that person puts into their body (food we eat, the air we breathe, the thoughts we think, and the toxins we’re exposed to), and how that interaction leads to their specific manifestations of illness In this way, we can determine the biochemical imbalances that have led to their particular illness, and understand how to correct them and truly heal Functional medicine is a science-based field of health care that is grounded in the following principles: Biochemical individuality describes the importance of individual variations in metabolic function that derive from genetic and environmental differences among individuals. Patient-centered medicine emphasizes "patient care" rather than "disease care," following Sir William Osler’s admonition that "It is more important to know what patient has the disease than to know what disease the patient has." Dynamic balance of internal and external factors.
“ like cures like.” - particular substance, when given at non-dilute doses, causes symptoms that it cures when given at homeopathic dosages. Energy Medicine - diluting and shaking (or “succussing”) a plant, mineral, or animal substance in a very special way higher dilution, higher potency changes the electromagnetic frequency of the remedy, so that even once the original substance is no longer detectable chemically, the changes in its energy fields make it more powerful with each successive dilution energy medicine The unique individual - treats a person’s unique emotional and physical manifestations of a particular illness. One person’s cold is not another person’s cold – what matters most is how that person is experiencing their cold. choosing the right homeopathic remedy requires understanding exactly what symptoms experiencing, both physically and emotionally. Innate healing capacity - stimulate the body’s natural ability to heal itself – “vital force” - allow body to recover from its illness more quickly. body also learns what to do the next time it faces the same infection. Administering and Dosing - little round “globules” that are lactose pellets coated with the remedy avoid touching the globules with your hands before putting them in your child’s mouth. take the globules “dry” and let slowly dissolve or chew and swallow them, OR crush between two spoons and dissolve in a little bit of water. Try not to eat or drink anything besides water for at least 20-30 minutes before and after taking the remedy. items that may antidote a homeopathic remedy: camphor, eucalyptus, peppermint, tea tree oil, coffee and pau d’arco tea – anything with a strong odor For most self-care, homeopathic remedies will be used at a potency of 30C, and dosed at 3 pellets 3 times daily. Remedies can be taken every 3 hours for acute conditions, but may even be dosed up to every 15-20 minutes for the first hour for very acute conditions Discontinue the remedy once a definite improvement is seen – sign that the body knows what to do to bring itself back into balance What to Expect - If right remedy, can feel better almost immediately. If no improvement p-4 doses, or sx change, may need to change remedy Safety - very safe and gentle, and often the preferred initial treatment for infants and pregnant/breastfeeding women. Because the actual initial substance is no longer detectable in the homeopathic remedy, even very poisonous substances like Belladonna can be given homeopathically without any harmful effects, despite the fact that they work potently to relieve various symptoms. Even if a child were to take a whole bottle of globules at once, no harmful effects should arise. Consult doctor before trying to treat a chronic issues as this may require what is called a constitutional remedy instead. Combination Remedies - Classical homeopathy uses a single remedy at a time Many combo remedies available - can work well if the right remedies that fit your child’s sx are in them
Herbs are natural drugs, and many of our drugs today are made from herbs and plants White willow bark – aspirin Foxglove – digitalis Contaminants – pesticides and heavy metals Know the manufacturer and the manufacturing process Make sure grow herbs as organically as possible Ayurvedic herbs from India – lead, arsenic, other heavy metals Chinese herbs from China – drugs (steroids), heavy metals General rule – only buy herbs manufactured in the US from a reputable company Kan, Gaia, HerbPharm, Eclectic Kids, Herbs for Kids Side effects and toxicities Herb-drug interactions St John’s Wort and birth control pills Herb-herb interactions
wonderful way to provide loving touch to your child while she is sick can be an effective means to provide relief for many of your child’s symptoms applies pressure to specific acupuncture points that stimulate the body’s healing energy in specific ways When you perform acupressure on your child, use the flat pads of your fingers or thumbs to apply firm pressure to each point for 1-5 minutes. May apply continuous pressure or massage the point. Acupressure points are along one of 12 invisible lines of energy called “meridians,” each of which corresponds to a specific organ system in Traditional Chinese Medicine These organ systems have specific fxns, and don’t necessarily correspond to the fxns that Western medicine gives to these organs Heart – houses the spirit or the shen Spleen – transforms food into qi, our vital energy that we need to thrive Kidney – stores our qi for use when we need it
Essential oils are a wonderful way to alleviate many of your child’s symptoms. When essential oils are inhaled, the scents immediately trigger a cascade of reactions that stimulate a part of our brain called the “limbic system.” The limbic system controls part of the brain that is linked with memory, breathing, blood circulation, and hormone regulation. The specific properties and fragrance of an essential oil will determine what action it will have on our bodies and our minds. The appropriate essential oil can have very beneficial healing properties for your child. It is important to use natural and pure essential oils from a reputable manufacturer to ensure that they will have the maximal therapeutic effects. Essential oils can be used in many different ways. Diffused - can be diffused into the air through a diffuser using heat or steam. Inhaled - You can put 5 drops into a bowl of hot water and inhale the steam. In bath - 5-10 drops can be added to a bath. Massaged - 5 drops can be added to a tablespoon of unscented vegetable oil (preferably organic) or lotion, and massaged into the body. This mixture can be used to massage the appropriate acupressure points to have an even more potent effect on your child’s symptoms. Some essential oils may be rubbed directly on to the skin, but ask your doctor first as some essential oils may be irritating when applied directly to the skin.
Enhance liver detoxification Make certain vitamins Antibiotic, antioxidant, and anticancer effects
Enhance liver detoxification Make certain vitamins Antibiotic, antioxidant, and anticancer effects
Delayed food allergies – really hard to know what food is causing which reaction
So a leaky gut can actually cause us to develop food sensitivities as we become progressively less well nourished
Infants already have a leaky gut, or altered intestinal permeability But, in susceptible babies, different factors can perpetuate or worsen this leaky gut So that babies continue to have this leak well after 6 mos, allowing food sensitivities to develop even if you wait until 6 mos to introduce solids IF your baby has had any of these issues that might exacerbate leaky gut, it might be worthwhile to delay the introduction of the more allergenic foods for even longer
Early antibiotic use associated with increased risk for eczema and asthma Kills not just the bad bacteria, but also the good bacteria Allowing abnormal bacteria and yeast to take over Interferes with the normal functioning of our immune system IF you must give your baby abx, please also give probiotics at the same time, to replace the good bacteria that is being killed off Zantac and other meds for reflux inhibit secretion of digestion enzymes baby’s food isn’t digested as well, which allows larger undigested food particles to enter the bloodstream from the intestine Which as we saw, can lead to an increased risk for food allergies
Food sensitivities can develop at any age
Once food allergies are identified, the key is to heal the leaky gut Functional medicine approach - Look at IFM website to find a functional medicine doctor for you or your child
Integrative Pediatric Rheumatology: How to help parents make the best decisions for their children
Integrative PediatricRheumatology:How to help parents make the bestdecisions for their children.Dana Gerstbacher, MDApril 20, 2013
2Goals Define Complementary and AlternativeMedicine and Integrative Medicine Review specific therapies used in PediatricRheumatology
3About Me Duke undergrad in Biology, Tufts University Schoolof Medicine LPCH Pediatric Residency LPCH Pediatric Rheumatology Fellowship University of Arizona Fellowship in IntegrativeMedicine Joined Whole Child Wellness, as a part-timeintegrative pediatrician in Oct 2010 Part-time Pediatric Rheumatology at Stanford
What is the immune system? The body’s defense against diseasecausing organisms, malfunctioning cells,and foreign particles5
THE BOY WITH A THORN IN HISJOINTSThe New York Times MagazineBy SUSANNAH MEADOWSPublished: February 1, 2013
7Don’t Take Medical Advice From theNew York Times MagazineThe dangerous chemophobia behind its popular storyabout childhood arthritis. Posted Thursday, Feb. 7, 2013, at 3:52 PM By Michelle Francl www.slate.com
8Chemophobia An irrational fear of chemicals “So here is my best advice to keep you fromsuccumbing to the chemophobia pandemic: One,everything is a chemical. Two, don’t take medicaladvice from a magazine writer, however impassionedand well-intentioned, however popular her story is onthe New York Times’ “most read” list, who trusts amassage therapist over medical experts. And three,there are risks to all chemicals, even the ones withfriendly names like Montmorency cherry juice andfour-marvels powder.” - Michelle Francl
What is Integrative Pediatrics?“Integrative Medicine is the practice of medicine thatreaffirms the importance of the relationship betweenpractitioner and patient, focuses on the whole person,is informed by evidence, and makes use of allappropriate therapeutic approaches, healthcareprofessionals and disciplines to achieve optimalhealth and healing”Consortium of Academic Health Centers for IntegrativeMedicine, May 2005
5 Complementary and Alternative medicine (CAM) A group of diverse medical and health caresystems, practices, and products Not considered part of conventional medicine Some scientific evidence exists regarding CAMtherapies For most, questions of safety and efficacy persist Integrative Medicine combines mainstream medicaltherapies and CAM therapies for which there is somehigh-quality scientific evidence of safety andeffectiveness.http://nccam.nih.gov/health/whatiscam/
Modalities• Functional Medicine• Herbal Medicine• Homeopathy• Traditional Chinese Medicine• Herbs and acupuncture/acupressure• Essential Oils/Aromatherapy
Toronto Sick Kids 1) the prevalence of current use of CAM by childrenwith rheumatic disease 2) the types of CAM currently used 3) any differences in the reported use of CAMbetween patients responding to a survey given in theclinic compared to one sent to the home 141 patients 90 (64%) used one CAM therapy 45 of the 90 (50%) used more then one therapyArthritis Rheum. 2003 Feb 15;49(1)
Multiple studies show that the most popular CAMtreatments are vitamins, herbal medicines, and dietarysupplements Evidence is lacking even for the most popular and eachremedy needs to be individually studied Even where evidence is promising, most studies are inadults However, the Institute of Medicine states: “the sameprinciples and standards of evidence of treatmenteffectiveness apply to all treatments whether currentlylabeled as conventional medicine or CAM”. Funding for research in CAM is growing but stillrelatively small in total amount (NIH/NCCAM)
NHIS: PEDIATRIC SUB-GROUPANALYSIS Characteristics of pediatric CAM users More likely to take prescription medications At least one parent who used CAM Chronic conditions such as anxiety or stress,musculoskeletal conditions, dermatologic conditions, orsinusitis. Research is required to guide pediatricians in makingrecommendations on CAM modalities for childrenincluding potential risks and/or benefits andinteractions with conventional therapies15
Functional Medicine/HolisticNutritionWhat is Functional Medicine?Functional medicine is a science-based field of health care that isgrounded in the following principles:Biochemical individuality describes the importance ofindividual variations in metabolic function that derive fromgenetic and environmental differences among individuals.Patient-centered medicine emphasizes "patient care" rather than"disease care," following Sir William Osler’s admonition that "Itis more important to know what patient has the disease than toknow what disease the patient has."Dynamic balance of internal and external factors.
Homeopathy “Like Cures Like” An energy medicine Treats the unique individual Stimulates the innate healing capacity Administering and dosing the remedy What to Expect Safety Combination Remedies
Herbal MedicineNatural ≠ Safe (necessarily) Herbs are natural drugs Contaminants Buy from a reputable manufacturer! Kan, Gaia, HerbPharm, Eclectic Kids, Herbs for Kids Side effects and toxicities Herb-drug interactions Herb-herb interactions
AcupressureLoving touchEffective means of symptom reliefUses acupuncture points
Essential OilsDirect stimulation of the brainMany therapeutic actionsUse only natural and pure essential oils Elizabeth van BurenWays to use essential oils Diffused Inhaled In bath Massaged
JIA and Functional Medicine –Reduce Inflammation Increase omega-3 fatty acids (EPA and DHA) Anti-inflammatory, Immune supporting, Lowerstriglycerides, Protects again heart disease, Stabilizes mood Wild salmon, cod liver oil/fish oil, pumpkin seeds, nuts www.epa.gov/fishadvisories/advice/ Good oils – olive, avocado, walnut, grapeseed, flaxseed,coconut, hempseed Increase GLA Anti-inflammatory omega-6 fatty acid Borage oil, black currant oil, evening primrose oil
JIA and Functional Medicine –Reduce Inflammation Increase probiotics “good bacteria” – fermented foods, kefir, yogurt, miso Klaire, Metagenics, Pharmax, Jarrow, Natren, Udo’s Choice Support detoxification; support immune system; makevitamins; antioxidant, anticancer, antimicrobial effects Increase antioxidant-rich foods Eat a “rainbow” Berries, broccoli, grapes, carrots, pomegranates, spinach,garlic
Antioxidant-Rich FoodsAntioxidant Good Food SourcesVitamin C Citrus fruits and their juices, berries, dark green vegetables(spinach, asparagus, green peppers, brussel sprouts,broccoli, watercress, other greens), red and yellow peppers,tomatoes and tomato juice, pineapple, cantaloupe, mangos,papaya and guava.Vitamin E Vegetable oils such as olive, soybean, corn, cottonseed andsafflower, nuts and nut butters, seeds, whole grains, wheat,wheat germ, brown rice, oatmeal, soybeans, sweetpotatoes, legumes (beans, lentils, split peas) and dark leafygreen vegetables.Selenium Brazil nuts, brewer’s yeast, oatmeal, brown rice, chicken, eggs,dairy products, garlic, molasses, onions, salmon, seafood,tuna, wheat germ, whole grains, most vegetables.Beta Carotene Variety of dark orange, red, yellow and green vegetables andfruits such as broccoli, kale, spinach, sweet potatoes,carrots, red and yellow peppers, apricots, cantaloupe andmangos.
JA and Functional Medicine –Reduce InflammationReduce pro-inflammatory foods Reduce omega-6 fatty acids Saturated fats, beef, poultry Reduce gluten World’s Healthiest Foods “Eat Right for YourCondition” (www.whfoods.com) Gluten wheat, rye, barley, kamut, spelt, ?oats Non-gluten grains – buckwheat, quinoa, rice, corn,millet, amaranth Reduce dairy
JA and Functional Medicine –Reduce InflammationReduce pro-inflammatory foods Reduce preservatives and additives Avoid nightshades Eggplant, tomatoes, bell peppers, whitepotatoes Reduce insulinogenic carbohydrates Eliminate trans fats Institute of Medicine “NO safe level” fortrans fats
Food Allergy vs. Sensitivity Food allergy Ig-E reaction to protein histamine hives,wheezing, diarrhea, life-threatening anaphylaxis Immediate reaction, within hours Not very common (<5% of the population) May be permanent Food sensitivity IgG reaction, not necessarily to protein Delayed reaction, up to 48-72 hours Very common up to 25-50% of population Can be cured Underlying cause LEAKY GUT
What is a Healthy Gut?Healthy smallintestine cells withno leak betweenthem allow smalldigested foodparticles into thebloodstream, butkeep largerallergenic particlesoutWith Permission, Patrick Hanaway, MD,Genova Diagnostics
What is a Leaky Gut?Damaged smallintestine cells withleaks let largerallergenic foodparticles intobloodstream anddon’t efficientlyallow digestednutritious foodparticles inWith Permission, Patrick Hanaway, MD,Genova Diagnostics
What if I suspect my child has foodsensitivity allergies/sensitivities? Elimination diet http://www.askdrsears.com/html/4/T041800.asp“Tracking Down Food Allergies” Food allergy testing Immediate (IgE) allergies RAST – lots of false negatives Skin test – lots of false positives Delayed (IgG) sensitivities Alletess IgG panel (www.foodallergy.com) Optimum Health Resource home testing kit (www.optimumhealthresource.com)
What if I suspect my child has foodallergies/sensitivities? Healing the leaky gut Remove the allergenic food for 2-3 months Repair the leak Omega-3 essential fatty acids Probiotics Prebiotics chicory, Jerusalem artichoke, asparagus, garlic, arabinogalactan Glutamine N-acetylglucosamine Anti-inflammatory herbs Quercetin, ginger, turmeric, rosemary, marshmallow, slippery elm www.functionalmedicine.org
JIA and Homeopathy Rhus toxicodendron “Creaky gate remedy”, stiffness and pain with firstmovement, better with continued motion but worsewith overuse, better with heat Ledum palestre Cracking in joints, worse with warmth, better withcold applications, affected area feels cold, esp ankles Bryonia alba Worse with any movement, better with deeppressure, irritable (“grumpy bear remedy”) Arnica montana Bruised feeling, sore after overexertion, worse withslightest touch or movement, wants to be left alone
JIA and Acupuncture Pain relief Different “local” points used depending onlocation of pain/swelling Strengthen immune system Qi-tonifying points Relaxation
JIA and Lifestyle Exercise Reduce stress! Yoga Meditation Qi Gong
Arthritis Foundation response tothe NYT article“We want to emphasize that comprehensivemedical care based on strong evidence is thebest and safest approach to the managementof children with Juvenile Arthritis.”–Coleen Ryan and Dr Helen Emery39
Decision making can be generally placed in fourcategories Safe and effective Safe but effectiveness unknown Unsafe but possibly effective Unsafe and likely ineffective “Why? What’s the evidence? How was it obtained? Is itplausible? And above all, what are the risks?” - Michelle Francl
Contact InformationDana Gerstbacher, MDElisa Song, MDDonna Ruiz, MDWhole Child Wellness, Inc.1601 El Camino RealBelmont, CA 94002650-595-KIDS (5437)