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Web of Dysfunction Kirti Kalidas M.D., N.D.

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  • Toxic substances can be from both external and internal sources. Food additives, chemical solvents from industrial waste, pesticides and herbicides, drugs, and alcohol are all substances that we ingest that need to be detoxified properly. These wastes do not only come from large industrial chemical factories. Many of these are the cleaners, pesticides and herbicides we use in and around our home.
    We also produce toxins internally from bacteria and yeasts that inhabit our gastrointestinal tract. If not handled properly, these can grow and cause imbalances that lead to disease.
    National Human Adipose Tissue Survey (http://www.epa.gov/chemrtk/vccep/vccepmth.htm)
    The National Adipose Tissue Survey (NHATS) analyzed human adipose (fatty) tissue specimens to monitor human exposure to potentially toxic chemicals. Pathologists and medical examiners from 47 metropolitan statistical areas collected tissue specimens from cadavers and surgical patients during the time period between 1970-1987. These specimens were analyzed for organochlorine pesticides, PCBs, dioxins and furans, volatile organics, semivolatile organics, and trace elements. However, not all compounds were analyzed over the complete time period from 1970 - 1987. Throughout the 1970's and early 1980's the chemical residues of primary interest where organochlorine pesticides and PCBs. During 1982, volatile and semivolatile organic compounds were included in the survey. NHATS was the primary activity of the National Human Monitoring Program (NHMP), operated by the EPA Office of Pollution Prevention and Toxics (USEPA/OPPT), until the early 1990s.
  • Toxic substances can be from both external and internal sources. Food additives, chemical solvents from industrial waste, pesticides and herbicides, drugs, and alcohol are all substances that we ingest that need to be detoxified properly. These wastes do not only come from large industrial chemical factories. Many of these are the cleaners, pesticides and herbicides we use in and around our home.
    We also produce toxins internally from bacteria and yeasts that inhabit our gastrointestinal tract. If not handled properly, these can grow and cause imbalances that lead to disease.
    National Human Adipose Tissue Survey (http://www.epa.gov/chemrtk/vccep/vccepmth.htm)
    The National Adipose Tissue Survey (NHATS) analyzed human adipose (fatty) tissue specimens to monitor human exposure to potentially toxic chemicals. Pathologists and medical examiners from 47 metropolitan statistical areas collected tissue specimens from cadavers and surgical patients during the time period between 1970-1987. These specimens were analyzed for organochlorine pesticides, PCBs, dioxins and furans, volatile organics, semivolatile organics, and trace elements. However, not all compounds were analyzed over the complete time period from 1970 - 1987. Throughout the 1970's and early 1980's the chemical residues of primary interest where organochlorine pesticides and PCBs. During 1982, volatile and semivolatile organic compounds were included in the survey. NHATS was the primary activity of the National Human Monitoring Program (NHMP), operated by the EPA Office of Pollution Prevention and Toxics (USEPA/OPPT), until the early 1990s.
  • Transcript

    • 1. Web of DysfunctionWeb of Dysfunction Kirti Kalidas M.D., N.D.Kirti Kalidas M.D., N.D. Board Certified Internal MedicineBoard Certified Internal Medicine Licensed Naturopathic PhysicianLicensed Naturopathic Physician Center for Natural and Integrative MedicineCenter for Natural and Integrative Medicine 407 355 9246407 355 9246 www.drkalidas.comwww.drkalidas.com
    • 2. Web of DysfunctionWeb of Dysfunction  BackgroundBackground • Medical school in South Africa, Residency andMedical school in South Africa, Residency and private practiceprivate practice • Frustration and need for changeFrustration and need for change  NaturopathyNaturopathy • Basic principlesBasic principles • ModalitiesModalities  Balance of MD and NDBalance of MD and ND  Web of DysfunctionWeb of Dysfunction
    • 3. MD/ND PerspectiveMD/ND Perspective Development of ParadigmDevelopment of Paradigm Broad ranged , multiple modalities-How do youBroad ranged , multiple modalities-How do you apply yourselfapply yourself  Disease vs Wellness paradigmDisease vs Wellness paradigm  Frustration of 2 years of practice: Acceptance,Frustration of 2 years of practice: Acceptance, new patients problem resolution, percentagenew patients problem resolution, percentage return visits, building inroads into the communityreturn visits, building inroads into the community  How quickly can I get to the root cause????How quickly can I get to the root cause????  Successful Practices: Focusing on one area,Successful Practices: Focusing on one area, modality or true integration in broad range ofmodality or true integration in broad range of conditionsconditions
    • 4. Liver, Pancreas, GB, Stomach Detox Insulin resistance Impaired digestion
    • 5. ISDISD  Chronic Infections : viral , bacterial, Fungal,Chronic Infections : viral , bacterial, Fungal, Parasitic, sites for occult low gradeParasitic, sites for occult low grade infections, Nanobacteria, Helicobacter,infections, Nanobacteria, Helicobacter, Chronic Lyme and co-infectionsChronic Lyme and co-infections  Auto immune conditionsAuto immune conditions  Asthma, allergies, Chemical hypersensitivityAsthma, allergies, Chemical hypersensitivity  Neurological: MS, tics, tremor, ChronicNeurological: MS, tics, tremor, Chronic pain, neuropathiespain, neuropathies
    • 6. What is my Toxic burden?What is my Toxic burden?  Maternal/Transplacental transferMaternal/Transplacental transfer  Immunizations/ thimerosal/flu shotsImmunizations/ thimerosal/flu shots  Environmental: pesticides, solvent, heavyEnvironmental: pesticides, solvent, heavy metals, occupational, Toys from China,metals, occupational, Toys from China, arsenic in playground equipment, airarsenic in playground equipment, air pollution etcpollution etc  Food and water sourcesFood and water sources  Habits: smoking, alcohol, recreationalHabits: smoking, alcohol, recreational  EMWaves etcEMWaves etc
    • 7. The need for metabolic detoxificationThe need for metabolic detoxification is increasing dailyis increasing daily  EPA Study of toxins in human adipose tissueEPA Study of toxins in human adipose tissue 11 • 100% of sampled contained plastics, solvents and100% of sampled contained plastics, solvents and dioxinsdioxins 22 • 83% also contained PCBs83% also contained PCBs  U.S. Pesticide use – 4 billion pounds annuallyU.S. Pesticide use – 4 billion pounds annually • 8 pounds for every man, woman and child8 pounds for every man, woman and child 33 • FDA Pesticide Residue MonitoringFDA Pesticide Residue Monitoring 44 • Pesticide residue was found in 50.5% of domesticPesticide residue was found in 50.5% of domestic fruits and 27.5% of domestic vegetablesfruits and 27.5% of domestic vegetables 1 EPA’s Office of Prevention, Pesticides and Toxic Substances 1999 2 US EPA National Adipose Tissue Survey 1982 4 Styrene, 1,4 Dichlorobenzen, xylene, ethylphenol, and TCDD 3 FDA Pesticide Program Residue Monitoring 2002 5 Body Burden, Environmental Working Group 2005 Over 167 synthetic chemicals and carcinogens are now found in the average human body5
    • 8. The need for metabolic detoxificationThe need for metabolic detoxification is increasing dailyis increasing daily  Over 167 synthetic chemicals and carcinogensOver 167 synthetic chemicals and carcinogens are now found in the average human body°are now found in the average human body°  EPA Study of toxins in human adipose tissueEPA Study of toxins in human adipose tissue۰۰ • 100% of sampled contained plastics,100% of sampled contained plastics, solvents and dioxins**solvents and dioxins** • 83% also contained PCB’s83% also contained PCB’s • U.S. Pesticide useU.S. Pesticide use4 billion pounds annually4 billion pounds annually 8 pounds for every man, woman and child8 pounds for every man, woman and child** ۰ US EPA National Adipose Tissue Survey, 1982 * EPA’s Office of Prevention, Pesticides and Toxic Substances, 1999 ° Body Burden, Environmental Working Group, 2005 **Styrene, 1,4 Dichlorobenzen, xylene, ethylphenol, and TCDD Research shows that this level of exposure to environmental toxins may lead to significant health challenges in your patients
    • 9. J Clin Pharmacol 1997;37(7):635-48.   Interpatient variability: genetic predisposition and other genetic factors. West WL, Knight EM, Pradhan S, Hinds TS. Center for Drug Abuse Research (CDAR), Howard University, Department of Pharmacology/Center for Drug Abuse Research, College of Medicine, Howard University, Washington, DC 20059, USA. Polymorphisms and other genetic factors related to enzymes metabolizing drugs and xenobiotic chemicals are well known. This article focuses on selected molecular mechanisms and introduces some of the clinical implications arising from genetically determined interpatient variability or expression in some of these enzymes. Selected are the polymorphic enzymes of cytochromes P-450 (CYP) as examples of phase I enzymes and methyl transferases, n-acetyl transferases, and glutathione-s-transferases as examples of phase II enzymes. The polymorphism surrounding arylhydrocarbon hydroxylase induction is briefly described. Phase I enzymatic reactions are predominantly oxidative, whereas phase II reactions often couple with the byproducts of phase I. Overall, in poor metabolizers, whether phase I or phase II, there is limited metabolism in most patients unless another major metabolic pathway involving other enzymes exists. Research identifies significant genetic variation in CYP450 Phase I enzyme expression in humans. These variations have a significant impact on the patients ability to clear toxins. Even genetic factors may be contributing to yourEven genetic factors may be contributing to your patients ability to clear toxinspatients ability to clear toxins
    • 10. Candida and DysbiosisCandida and Dysbiosis  Traditional MD thinking and trainingTraditional MD thinking and training  Candida – invasive vs overgrowthCandida – invasive vs overgrowth  GI balance and wellnessGI balance and wellness  Antibiotics in foodsAntibiotics in foods  Probiotics in FoodsProbiotics in Foods
    • 11. Permeability, Food Sensitivity,Permeability, Food Sensitivity, Nutritional deficiencyNutritional deficiency  What is the trueWhat is the true nutritional status ofnutritional status of our patientsour patients  Is my bag of pillsIs my bag of pills working for meworking for me  Type of dietType of diet  Empiric treatmentEmpiric treatment until results available-until results available- Key nutrient supportKey nutrient support and possible IVand possible IV supportsupport
    • 12. CNS and HP DysfunctionCNS and HP Dysfunction  History of trauma, abuse, stressors-History of trauma, abuse, stressors- move, job, financial, student loans,move, job, financial, student loans, marital, relationship, toxic exposuremarital, relationship, toxic exposure  The switch/fuse box- Fatigue toThe switch/fuse box- Fatigue to Fantastic Dr Teitalbaum---THINS—Fantastic Dr Teitalbaum---THINS— Toxic, Hormonal, Infectious,Toxic, Hormonal, Infectious, Nutritional, SleepNutritional, Sleep
    • 13. Hormonal ImbalanceHormonal Imbalance  Thyroid vs. adrenal or combinedThyroid vs. adrenal or combined symptomssymptoms  Classic signs and symptoms ofClassic signs and symptoms of hypothyroidismhypothyroidism  Functional hypothyroidism and testingFunctional hypothyroidism and testing  Show severity of adrenal imbalanceShow severity of adrenal imbalance fatigue /burnoutfatigue /burnout  Low dose thyroid supportLow dose thyroid support  Use of bio identical hormones in womenUse of bio identical hormones in women  Testosterone use in clinical practiceTestosterone use in clinical practice  Melatonin, growth hormone etcMelatonin, growth hormone etc
    • 14. Test used in my practiceTest used in my practice  Basic core labsBasic core labs • Additional bloodAdditional blood test, Cardiac,test, Cardiac, Rheum, LymeRheum, Lyme  Salivary hormonesSalivary hormones  Heavy metalHeavy metal testingtesting  SpectracellSpectracell  Food sensitivitiesFood sensitivities  CSA with parasitesCSA with parasites  Organic AcidOrganic Acid testingtesting  NeuroscienceNeuroscience  Gluten /casein peptideGluten /casein peptide  Metallotheinin/Zn andMetallotheinin/Zn and coppercopper  US, CT, MRI etcUS, CT, MRI etc  FFA analysis, hepaticFFA analysis, hepatic detox pathwaydetox pathway  Condition specific testCondition specific test
    • 15. Case Study 1Case Study 1 42 year dental professional with42 year dental professional with chronic GI symptoms, chronicchronic GI symptoms, chronic palpitations, resting heart rate ofpalpitations, resting heart rate of 100-110 bpm, failed medical and 3100-110 bpm, failed medical and 3 ablation attemptsablation attempts Test orderedTest ordered Treatment and resolution of symptomsTreatment and resolution of symptoms in 3 monthsin 3 months
    • 16. Case 2Case 2  38 yr female background history38 yr female background history myalgia, 2 auto accidents,myalgia, 2 auto accidents, exacerbation of RSD symptoms for 8exacerbation of RSD symptoms for 8 years. TMJ surgery x2. Chronic painyears. TMJ surgery x2. Chronic pain and spasm requiring massageand spasm requiring massage therapy twice weekly with minimaltherapy twice weekly with minimal improvementimprovement  TestTest  TreatmentTreatment
    • 17. Case 3Case 3  51 yr old female , failed 22 MD51 yr old female , failed 22 MD treatment over 3 years for chronictreatment over 3 years for chronic leg pain, sensitivity,leg pain, sensitivity, hyperparasthesia, fatigue,hyperparasthesia, fatigue, perimenopausal symptoms andperimenopausal symptoms and chronic constipation.chronic constipation.  Impression and testImpression and test  Course of treatmentCourse of treatment
    • 18. Case 4Case 4  39 yr female with chronic fatigue,39 yr female with chronic fatigue, weight gain, hypothyroidism, 7yearsweight gain, hypothyroidism, 7years of stress with son with sensoryof stress with son with sensory integrative issuesintegrative issues  Not much hope given byNot much hope given by endocrinologistendocrinologist  Physical evaluationPhysical evaluation  TestTest  outcomeoutcome
    • 19. Case 5Case 5  42 yr disabled wheelchair bound, 342 yr disabled wheelchair bound, 3 failed back surgeries, chronicfailed back surgeries, chronic persistent leg pain, Reactive airwayspersistent leg pain, Reactive airways Disease on Oxygen, chronic foleyDisease on Oxygen, chronic foley catheter use and scheduled bladdercatheter use and scheduled bladder surgerysurgery  TestsTests  Treatment and outcomeTreatment and outcome
    • 20. Case 6Case 6  4 year old Asian male , nonverbal ,4 year old Asian male , nonverbal , gross motor normal, poor fine motorgross motor normal, poor fine motor skills , advised by pediatricskills , advised by pediatric neurologist to continue monitoringneurologist to continue monitoring and bring him back if he hasand bring him back if he has seizuresseizures  TestTest  TreatmentTreatment
    • 21. Case 7Case 7  54 yr old with RA and weight gain54 yr old with RA and weight gain and stress post hurricane in 2005and stress post hurricane in 2005  PhysicalPhysical  TestTest  OutcomeOutcome
    • 22. Case 8Case 8  45 year old school teacher with45 year old school teacher with Fatigue, Asthma, Anemia, fibroids,Fatigue, Asthma, Anemia, fibroids, recurrent URI and bronchitis andrecurrent URI and bronchitis and Family history of ovarian cancerFamily history of ovarian cancer  TestTest  treatmenttreatment
    • 23. Case 9Case 9  46 yr old female with CFS for 1046 yr old female with CFS for 10 years, fibromyalgia, joint pain andyears, fibromyalgia, joint pain and severe “brain fog”. Seen by multiplesevere “brain fog”. Seen by multiple physicians and alternative doctorsphysicians and alternative doctors  Evaluation and testEvaluation and test  Treatment and outcomeTreatment and outcome
    • 24. Case 10Case 10  8 yr old WM with 3 year history of8 yr old WM with 3 year history of abdominal pain , full GI workup,abdominal pain , full GI workup, learning disorderlearning disorder  TestTest  TreatmentTreatment  Outcome in 3-4 monthsOutcome in 3-4 months
    • 25. Take HomeTake Home  Our health is a product of gene expression, toxicOur health is a product of gene expression, toxic exposure, functional and hormonal imbalancesexposure, functional and hormonal imbalances and lifestyle choicesand lifestyle choices  Integration of modalitiesIntegration of modalities  Working with MD’s and other health careWorking with MD’s and other health care providersproviders  Stepwise testing and support and addressingStepwise testing and support and addressing each areaeach area  Optimizing health, hope and healing byOptimizing health, hope and healing by addressing the root causeaddressing the root cause

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