This document summarizes a presentation on hot topics in integrative medicine, including chronic pain management, the microbiome, menopausal symptoms, mindfulness, elimination diets, and acupuncture. It reviews evidence for approaches like physical activity, anti-inflammatory diets, probiotics, and supplements for chronic pain, irritable bowel syndrome, obesity, and diabetes. Non-hormonal therapies for menopausal symptoms like CBT, yoga, and acupuncture are discussed. Mindfulness-based stress reduction and elimination diets are described as commonly used integrative therapies. The document concludes by listing resources for integrative medicine evidence.
What is gut microbiota? What is the influence of diet on the proper functioning of our gut microbiota? How does the gut-brain axis (GBA) influence the emotional and cognitive centers of the brain? Tune into this webinar to find out more about this timely topic.
Learning Objectives:
List the neurological and physiological connections that enable the bidirectional communication between the gut and the brain
Identify lifestyle, dietary, and microbial influences on the flow and function of signaling molecules along the gut-microbiota-brain axis
Implement dietary regimens that target the gut and gastrointestinal microbiota to improve or maintain optimal physical and mental health
RDNs earn 1.0 CEU
iCAAD London 2019 - Prof Wulf Rossler - NUTRITION, SLEEP AND PHYSICAL EXERCI...iCAADEvents
Until recently nutrition and various other lifestyle factors were predominantly in the focus of medical disciplines like cardiology, endocrinology or gastroenterology. As mental disorders are multifactorial diseases and as such are complex, emerging evidence suggests that nutrition, exercise and sleep also play an important role in the aetiology, progression and treatment of mental disorders.
What is gut microbiota? What is the influence of diet on the proper functioning of our gut microbiota? How does the gut-brain axis (GBA) influence the emotional and cognitive centers of the brain? Tune into this webinar to find out more about this timely topic.
Learning Objectives:
List the neurological and physiological connections that enable the bidirectional communication between the gut and the brain
Identify lifestyle, dietary, and microbial influences on the flow and function of signaling molecules along the gut-microbiota-brain axis
Implement dietary regimens that target the gut and gastrointestinal microbiota to improve or maintain optimal physical and mental health
RDNs earn 1.0 CEU
iCAAD London 2019 - Prof Wulf Rossler - NUTRITION, SLEEP AND PHYSICAL EXERCI...iCAADEvents
Until recently nutrition and various other lifestyle factors were predominantly in the focus of medical disciplines like cardiology, endocrinology or gastroenterology. As mental disorders are multifactorial diseases and as such are complex, emerging evidence suggests that nutrition, exercise and sleep also play an important role in the aetiology, progression and treatment of mental disorders.
Assignment #1 – This assignment should help you to organize your t.docxdavezstarr61655
Assignment #1 – This assignment should help you to organize your thoughts about your research. Take time to really think about the questions – this effort will make writing the actual paper much easier. Please complete this worksheet and submit on Bb. You need to submit only once per pair (make sure I know who you are working with!).
1. With your partner, develop a research question. Write your research question here:
*Please ensure that the question is not answered by the book’s author.
Question is. "How has the development in human society led to the increased frequency of obesity?"
2. Why do you have this question? Please write a paragraph or two explaining your interest in this question. Give specific information from the book that leads you to ask this question (include page numbers). Explain how this information relates to your question.
Obesity in the whole world has become a public health problem in that it has raised concern. About 700 million people aged 15 years and above in the entire world are obese. The prevalence rate of based on years past shows a rapid increase of obesity in developed countries mainly Pacific region. Various cancers, cardiovascular diseases-morbidities, type II diabetes are some of the factors which lead to morbidity and mortality; this is based on literature on body exhaustive.
A public health strategy is, therefore, to be developed based on prevention of obesity rate of increase. The development and also the process of policies on preventing obesity should target factors which tend to contribute to obesity. Moreover, it should target barriers to lifestyle changes which are personal and also environmental and levels socioeconomic.
There are etiologies which contribute to obesity in which this etiologies are multifactorial,some if these factors include sedentary lifestyle, adverse socio-economic conditions which are there in developed countries, high rate of energy dense food, rigid restraint, alcohol, large portion sizes and food ratio which are prepared outside home (mostly in developed countries) page 70 (International journal of environmental research and public health).
There is a proposed framework by sacks (2009) where a suggestion is made that there should be policy actions and implementation of health strategies to preventing obesity. These factors target environments, behaviors directly influencing people, physical activity settings, food environments and also the socioeconomic environments.
3. What do you need to learn as a biologist to understand your question in the context of human evolution?
Obesity, diabetes and also metabolic syndrome has become a worldwide health concern due to that they are growing rapidly, and their causes are not fully understood. Therefore a research into the obesity epidemic etiology is highly appreciated depending on the evolutionary roots of metabolic control. Thrifty gene hypothesis argues that obesity is an evolutionary roots of metabolic control .
With a growing number of conditions being grouped under the ‘umbrella’ of autoimmune disease, supporting clients who are, increasingly, presenting with various, and often multiple, autoimmune conditions, can appear complex at first glance.
In this webinar, Dr Danielle Crida outlines a clinical protocol that can support most autoimmune conditions, and takes a deep dive into the role of the immune system and key inflammatory processes at play.
Intermittent fasting had a strong anti inflammatory effect beside the many other benefits. Intermittent fasting is an eating pattern and Interventional strategy where in individuals are subjected to varying periods of fasting. It doesn’t specify which foods you should eat but rather when you should eat them. Intermittent fasting (IF) is an eating pattern that cycles between periods of fasting and eating. It’s currently very popular in the health and fitness community. Recently attracted attention because:
1- Its Evidence-Based Health Benefits
2- Its potential for correcting metabolic Abnormalities
3- Better adherence than other methods
The Journal of NutritionNutrition and DiseaseBioactive.docxoreo10
The Journal of Nutrition
Nutrition and Disease
Bioactives in Blueberries Improve Insulin
Sensitivity in Obese, Insulin-Resistant Men
and Women1–4
April J. Stull, Katherine C. Cash, William D. Johnson, Catherine M. Champagne, and William T. Cefalu*
Center for the Study of Botanicals and Metabolic Syndrome, Pennington Biomedical Research Center, Louisiana State University System,
Baton Rouge, LA 70808
Abstract
Dietary supplementation with whole blueberries in a preclinical study resulted in a reduction in glucose concentrations
over time. We sought to evaluate the effect of daily dietary supplementation with bioactives from blueberries on
whole-body insulin sensitivity in men and women. A double-blinded, randomized, and placebo-controlled clinical study
design was used. After screening to resolve study eligibility, baseline (wk 0) insulin sensitivity was measured on 32
obese, nondiabetic, and insulin-resistant subjects using a high-dose hyperinsulinemic-euglycemic clamp (insulin
infusion of 120 mU(861 pmol)×m22×min21). Serum inflammatory biomarkers and adiposity were measured at baseline.
At the end of the study, insulin sensitivity, inflammatory biomarkers, and adiposity were reassessed. Participants
were randomized to consume either a smoothie containing 22.5 g blueberry bioactives (blueberry group, n = 15) or a
smoothie of equal nutritional value without added blueberry bioactives (placebo group, n = 17) twice daily for 6 wk.
Both groups were instructed to maintain their body weight by reducing ad libitum intake by an amount equal to the
energy intake of the smoothies. Participants’ body weights were evaluated weekly and 3-d food records were
collected at baseline, the middle, and end of the study. The mean change in insulin sensitivity improved more in the
blueberry group (1.7 6 0.5 mg×kg FFM21×min21) than in the placebo group (0.4 6 0.4 mg×kg FFM21×min21) (P = 0.04).
Insulin sensitivity was enhanced in the blueberry group at the end of the study without significant changes in
adiposity, energy intake, and inflammatory biomarkers. In conclusion, daily dietary supplementation with bioactives
from whole blueberries improved insulin sensitivity in obese, nondiabetic, and insulin-resistant participants. J. Nutr.
140: 1764–1768, 2010.
Introduction
Increased consumption of berries has been shown to improve
cognitive function, risk of cardiovascular disease, and cancer
(1,2). Studies have also reported that specific berries, i.e.,
blueberries, have antidiabetic effects. Specifically, a study
performed in mice (3) found that supplementation with
whole blueberries reduced the blood glucose area under the
curve (AUC)5 in vivo and cell culture studies (4,5) demonstrated
increased glucose uptake in vitro (6). In addition, inflammatory
genes have been reduced in mice after consuming blueberry
bioactives, which suggests an antiinflammatory response (3).
The purported health benefits from blueberries have been
attributed to their ...
Wellness Nutrients
Nutritional Supplementation
SWU 351 Sustainable Living and Mindful Eating
Objectives
By the end of class you should be able to:
Identify a variety of “wellness supplements”
Identify populations who may and may not benefit from taking a multivitamin
Define “functional foods”
The Problem
The vast majority of Americans do not meet minimum RDA standards of vitamins and minerals
93% of vitamins D and E miss recommendations from diet
61% not enough magnesium
50% not enough Vitamin A and Calcium
Many subpopulations have lower than recommended intake
older adults (over 65+)
African Americans
Obese individuals
Those who are ill or injured
Do We Need Supplements
to be “Well”?
Health maintenance and prevention of disease
Almost 1/2 of the adult population takes supplements of one form or another
What supplements do people take to be well?
Deficiency Issues
Micronutrients (vitamins and minerals) provide:
maintenance of normal cell and tissue function, metabolism, growth and development
True Deficiency Diseases are Rare in the United States
more problems from over nutrition, not malnutrition
Supplements offer an unregulated promise of health in a bottle
It is BIG BUSINESS, with BIG PROFITS
Can a healthful diet provide adequate protection? Or, are supplements the answer?
Common Wellness Supplements
MVI’s
Fish Oil and Flax Oil
Vitamin D
Antioxidants such as vitamins C and E and beta carotene
Gene Polymorphisms
Since the mapping of the human genome, multiple single nucleotide polymorphisms (SNPs) have been identified that can affect nutritional status and potentially, overall health
Common SNPs
MTHFR
Vitamin D receptor
Fatty Acid Desaturases (FADS)
PEMT (choline)
Lipoprotein polymorphisms…
FASEB J. 2005 Oct;19(12):1602-16
Healthy Eating Index 2005
Measures adequacy, moderation and variety
(fat, cholesterol, sodium , FGP…)
Data set is from 1999 - 2000
74% of population has a diet that “needs improvement”
10% have a “good diet”
16% of population has a “poor diet”
http://www.cnpp.usda.gov/publications/HEI/HEI99-00report.pdf
Americans Do Not Meet Federal Dietary Recommendations
2001 – 2004 NHANES (16,338 ppl aged 2 and older)
24 hr recall translated into food groups using My Pyramid Equivalents Database
The population did not meet recommendations for all of the nutrient rich food groups except for total grains, meat and beans (categories: fruits, veg, dark green veg, orange veg, legume, starchy veg, other veg, milk, total grains, meat and beans, oils)
Dark greens, orange veg, legumes and whole grains had the poorest showing and 90% of the population did not meet recommendations for total veg and milk.
80 – 90% of Americans are over-consuming fat, sugar, & ETOH
Krebs-Smith et al. J Nutr. 2010 Oct;140(10):1832-8.
Toxic World?
Textbook of Functional Medicine. Institute for Functional Medicine. Gig Harbor, WA. 2005
Do we have evidence that taking MVI’s / Supplements provide benefit?
...
What is health? NUGO International nutrigenomics Conference Wageningen Sept 9...Norwich Research Park
What is health? Can Nutrigenomics allow to quantify metabolic health? (YES)
My very personal conclusions of a wonderful conference (NUGO Week 2011) in Wageningen (The Netherlands) that we organized.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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Similar to Hot Topics In Integrative Medicine Jill Schneiderhan.pptx
Assignment #1 – This assignment should help you to organize your t.docxdavezstarr61655
Assignment #1 – This assignment should help you to organize your thoughts about your research. Take time to really think about the questions – this effort will make writing the actual paper much easier. Please complete this worksheet and submit on Bb. You need to submit only once per pair (make sure I know who you are working with!).
1. With your partner, develop a research question. Write your research question here:
*Please ensure that the question is not answered by the book’s author.
Question is. "How has the development in human society led to the increased frequency of obesity?"
2. Why do you have this question? Please write a paragraph or two explaining your interest in this question. Give specific information from the book that leads you to ask this question (include page numbers). Explain how this information relates to your question.
Obesity in the whole world has become a public health problem in that it has raised concern. About 700 million people aged 15 years and above in the entire world are obese. The prevalence rate of based on years past shows a rapid increase of obesity in developed countries mainly Pacific region. Various cancers, cardiovascular diseases-morbidities, type II diabetes are some of the factors which lead to morbidity and mortality; this is based on literature on body exhaustive.
A public health strategy is, therefore, to be developed based on prevention of obesity rate of increase. The development and also the process of policies on preventing obesity should target factors which tend to contribute to obesity. Moreover, it should target barriers to lifestyle changes which are personal and also environmental and levels socioeconomic.
There are etiologies which contribute to obesity in which this etiologies are multifactorial,some if these factors include sedentary lifestyle, adverse socio-economic conditions which are there in developed countries, high rate of energy dense food, rigid restraint, alcohol, large portion sizes and food ratio which are prepared outside home (mostly in developed countries) page 70 (International journal of environmental research and public health).
There is a proposed framework by sacks (2009) where a suggestion is made that there should be policy actions and implementation of health strategies to preventing obesity. These factors target environments, behaviors directly influencing people, physical activity settings, food environments and also the socioeconomic environments.
3. What do you need to learn as a biologist to understand your question in the context of human evolution?
Obesity, diabetes and also metabolic syndrome has become a worldwide health concern due to that they are growing rapidly, and their causes are not fully understood. Therefore a research into the obesity epidemic etiology is highly appreciated depending on the evolutionary roots of metabolic control. Thrifty gene hypothesis argues that obesity is an evolutionary roots of metabolic control .
With a growing number of conditions being grouped under the ‘umbrella’ of autoimmune disease, supporting clients who are, increasingly, presenting with various, and often multiple, autoimmune conditions, can appear complex at first glance.
In this webinar, Dr Danielle Crida outlines a clinical protocol that can support most autoimmune conditions, and takes a deep dive into the role of the immune system and key inflammatory processes at play.
Intermittent fasting had a strong anti inflammatory effect beside the many other benefits. Intermittent fasting is an eating pattern and Interventional strategy where in individuals are subjected to varying periods of fasting. It doesn’t specify which foods you should eat but rather when you should eat them. Intermittent fasting (IF) is an eating pattern that cycles between periods of fasting and eating. It’s currently very popular in the health and fitness community. Recently attracted attention because:
1- Its Evidence-Based Health Benefits
2- Its potential for correcting metabolic Abnormalities
3- Better adherence than other methods
The Journal of NutritionNutrition and DiseaseBioactive.docxoreo10
The Journal of Nutrition
Nutrition and Disease
Bioactives in Blueberries Improve Insulin
Sensitivity in Obese, Insulin-Resistant Men
and Women1–4
April J. Stull, Katherine C. Cash, William D. Johnson, Catherine M. Champagne, and William T. Cefalu*
Center for the Study of Botanicals and Metabolic Syndrome, Pennington Biomedical Research Center, Louisiana State University System,
Baton Rouge, LA 70808
Abstract
Dietary supplementation with whole blueberries in a preclinical study resulted in a reduction in glucose concentrations
over time. We sought to evaluate the effect of daily dietary supplementation with bioactives from blueberries on
whole-body insulin sensitivity in men and women. A double-blinded, randomized, and placebo-controlled clinical study
design was used. After screening to resolve study eligibility, baseline (wk 0) insulin sensitivity was measured on 32
obese, nondiabetic, and insulin-resistant subjects using a high-dose hyperinsulinemic-euglycemic clamp (insulin
infusion of 120 mU(861 pmol)×m22×min21). Serum inflammatory biomarkers and adiposity were measured at baseline.
At the end of the study, insulin sensitivity, inflammatory biomarkers, and adiposity were reassessed. Participants
were randomized to consume either a smoothie containing 22.5 g blueberry bioactives (blueberry group, n = 15) or a
smoothie of equal nutritional value without added blueberry bioactives (placebo group, n = 17) twice daily for 6 wk.
Both groups were instructed to maintain their body weight by reducing ad libitum intake by an amount equal to the
energy intake of the smoothies. Participants’ body weights were evaluated weekly and 3-d food records were
collected at baseline, the middle, and end of the study. The mean change in insulin sensitivity improved more in the
blueberry group (1.7 6 0.5 mg×kg FFM21×min21) than in the placebo group (0.4 6 0.4 mg×kg FFM21×min21) (P = 0.04).
Insulin sensitivity was enhanced in the blueberry group at the end of the study without significant changes in
adiposity, energy intake, and inflammatory biomarkers. In conclusion, daily dietary supplementation with bioactives
from whole blueberries improved insulin sensitivity in obese, nondiabetic, and insulin-resistant participants. J. Nutr.
140: 1764–1768, 2010.
Introduction
Increased consumption of berries has been shown to improve
cognitive function, risk of cardiovascular disease, and cancer
(1,2). Studies have also reported that specific berries, i.e.,
blueberries, have antidiabetic effects. Specifically, a study
performed in mice (3) found that supplementation with
whole blueberries reduced the blood glucose area under the
curve (AUC)5 in vivo and cell culture studies (4,5) demonstrated
increased glucose uptake in vitro (6). In addition, inflammatory
genes have been reduced in mice after consuming blueberry
bioactives, which suggests an antiinflammatory response (3).
The purported health benefits from blueberries have been
attributed to their ...
Wellness Nutrients
Nutritional Supplementation
SWU 351 Sustainable Living and Mindful Eating
Objectives
By the end of class you should be able to:
Identify a variety of “wellness supplements”
Identify populations who may and may not benefit from taking a multivitamin
Define “functional foods”
The Problem
The vast majority of Americans do not meet minimum RDA standards of vitamins and minerals
93% of vitamins D and E miss recommendations from diet
61% not enough magnesium
50% not enough Vitamin A and Calcium
Many subpopulations have lower than recommended intake
older adults (over 65+)
African Americans
Obese individuals
Those who are ill or injured
Do We Need Supplements
to be “Well”?
Health maintenance and prevention of disease
Almost 1/2 of the adult population takes supplements of one form or another
What supplements do people take to be well?
Deficiency Issues
Micronutrients (vitamins and minerals) provide:
maintenance of normal cell and tissue function, metabolism, growth and development
True Deficiency Diseases are Rare in the United States
more problems from over nutrition, not malnutrition
Supplements offer an unregulated promise of health in a bottle
It is BIG BUSINESS, with BIG PROFITS
Can a healthful diet provide adequate protection? Or, are supplements the answer?
Common Wellness Supplements
MVI’s
Fish Oil and Flax Oil
Vitamin D
Antioxidants such as vitamins C and E and beta carotene
Gene Polymorphisms
Since the mapping of the human genome, multiple single nucleotide polymorphisms (SNPs) have been identified that can affect nutritional status and potentially, overall health
Common SNPs
MTHFR
Vitamin D receptor
Fatty Acid Desaturases (FADS)
PEMT (choline)
Lipoprotein polymorphisms…
FASEB J. 2005 Oct;19(12):1602-16
Healthy Eating Index 2005
Measures adequacy, moderation and variety
(fat, cholesterol, sodium , FGP…)
Data set is from 1999 - 2000
74% of population has a diet that “needs improvement”
10% have a “good diet”
16% of population has a “poor diet”
http://www.cnpp.usda.gov/publications/HEI/HEI99-00report.pdf
Americans Do Not Meet Federal Dietary Recommendations
2001 – 2004 NHANES (16,338 ppl aged 2 and older)
24 hr recall translated into food groups using My Pyramid Equivalents Database
The population did not meet recommendations for all of the nutrient rich food groups except for total grains, meat and beans (categories: fruits, veg, dark green veg, orange veg, legume, starchy veg, other veg, milk, total grains, meat and beans, oils)
Dark greens, orange veg, legumes and whole grains had the poorest showing and 90% of the population did not meet recommendations for total veg and milk.
80 – 90% of Americans are over-consuming fat, sugar, & ETOH
Krebs-Smith et al. J Nutr. 2010 Oct;140(10):1832-8.
Toxic World?
Textbook of Functional Medicine. Institute for Functional Medicine. Gig Harbor, WA. 2005
Do we have evidence that taking MVI’s / Supplements provide benefit?
...
What is health? NUGO International nutrigenomics Conference Wageningen Sept 9...Norwich Research Park
What is health? Can Nutrigenomics allow to quantify metabolic health? (YES)
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Hot Topics In Integrative Medicine Jill Schneiderhan.pptx
1. Hot Topics In Integrative
Medicine
Jill Schneiderhan MD
October 20, 2017
2. Objectives
Participants will be able to review up to date evidence based
knowledge about common integrative medicine topics in
primary care.
Chronic Pain Management
Microbiome
Vasomotor Symptoms of Menopause
Participants will be able to review common complementary
and alternative medicine techniques and what conditions
they are best used to treat.
Mindfulness
Elimination Diet
Acupuncture
Participants will be able to list where they can go to find
evidence based treatment options related to Integrative
Medicine.
3. Integrative Medicine
Approaching each patient where they are
Combining the best of our current evidence base with
whole person oriented approaches that take into account
mental, physical, emotional, spiritual aspects of health
and wellness
Foundation of Wellness
Activity
Diet/Nutrition
Sleep
Stress/Emotional Regulation
5. Chronic Pain
Significant advances in understanding of physiology
have not equaled improvement in treatments
Most treatments overall are poor to fair
Most average around 30% effective in improving pain
(roughly equal to placebo)
Even if a treatment improves pain it rarely provides
concomitant physical or emotional functional
improvements
Turk, D. C., Wilson, H. D., & Cahana, A. (2011). The Lancet, 377(9784), 2226-2235.
7. Physical Activity
Fear of damage from pain often leads to less activity
leading to tightening of muscles and increased pain in a
negative cycle
For most chronic pain conditions graded exercise
programs are shown beneficial
30% improvement for low back pain
Most effective for centralized pain conditions
Cunningham, N. R., & Kashikar-Zuck, S. (2013). Nonpharmacological treatment of pain in rheumatic
diseases and other musculoskeletal pain conditions. Curr Rheumatol Rep, 15(2), 306.
8. Obesity and Inflammation
For many obese patients there is chronic non-resolving
inflammation1
CRP is an accepted marker of chronic inflammation
Elevated CRP has been shown preliminarily to increase
rates of low back pain
Higher elevation in patients who are obese2
1. Arranz, L. I., et al. Curr Rheumatol Rep. 2014. 2. Briggs, M., et al. Arch Phys Med Rehabil. 2012.
9. Inflammation
Chronic inflammation promotes nociception
Chronic non-resolving inflammation is associated with:
Low back pain, arthritis, RA, MS, atherosclerotic disease,
diabetes1
Western diets low in fruits and vegetable (natural
antioxidants) and high in red meat (generator of IL-6)
promote inflammation2
1. Seaman, D. Chiropractic & Manual Therapies, 2013. 2. Esposito, K., eta l. Eur Heart J,
2006.
10. Diet as Treatment
Diets high in fruits, vegetables, fiber and Omega 3 Fatty
Acids decrease inflammation1
Anti-Inflammatory Diet – high in fruits, vegetables,
legumes, healthy oils, omega 3
Mediterranean Diet – high in vegetables, fish, olive oil as
main fat2
1. Esposito, K., et al. Eur Heart J, 2006. 2. Esposito, K., et al. JAMA, 2004.
11. Supplements
Omega 3 Fatty Acids - 3 grams daily DHA/EPA1
Vitamin D – keep level between 30-502
Magnesium ( Magnesium glycinate or chelated
magnesium) – 400mg a night and titrate to tolerance3
Tumeric 500mg QID4
1. Esposito, K., et al. Eur Heart J, 2006. 2. Esposito, K., et al. JAMA, 2004. 3. Yousef, A. A., et al. Anaesthesia,
2013. 4. Tizabi, Y., et al. Molecules, 2014.
12. The Microbiome
The microbiome consists of all the microbes that live on
and in humans
Contributes 99% of the genetic material in the human
body
The highest number of organisms are found inside the
gastrointestinal tract
Most are bacteria
90% are anaerobic
Tsukumo DM et. Al. Archives of endocrinology and metabolism. Apr 2015
13. Functions of the Gut Flora
Role in Digestion/Nutrition
Supplying essential nutrients through their breakdown of complex
carbohydrates
Generating secondary bile acids that assist in the digestion of fats1
Synthesizing vitamins such as Vitamins K, B12, folate, and biotin2
Role in Immune System/Protection
Contribute to the defensive barrier in the colon
stimulate mucous production, lymphatic tissue development, antibody
formation
Induce protective cytokines, suppress pro-inflammatory cytokines in
the mucosa of patients through the actions of Short Chain Fatty Acids
(SCFA’s) 3
Interact with our systemic immune system in a way that
maintains a level of homeostasis
Allowing for the appropriate activation
With NO autoimmunity.3
1. Conlon MA, Bird AR. Nutrients. Jan 2015. 2. Nicholson JK, et al. Science. June 2012. 3. Zhang YJ, et al.
International journal of molecular sciences. 2015.
14. Functions of the Gut Flora
Role in Gut-Brain Axis
Bidirectional communication
Brain can signal enteric nervous system to speed up or
slow down transit time
Neurotransmitters generated by gut bacteria can affect
pathways in the CNS
Hormonal signaling
Nervous system communication1,2
Modulate pain perception
L acidophilus induces expression of mu-opioid
and cannabinoid receptors in intestinal
epithelial cells, mediates analgesic
functions similar to morphine3
1. Tillisch K. Gut microbes. May 2014. 2. Cong X, Hender et al. Advances in neonatal care :
official journal of the National Association of Neonatal Nurses. Oct 2015. 3. Rousseaux C, et al.
Nat Med. Jan 2007.
15. Irritable Bowel Syndrome
Probiotics associated with decreased pain, bloating,
urgency 1,2
Restore more normal gut microflora, improve intestinal
permeability, normalize imbalances in inflammatory
cytokine ratios
Soluble fiber, commonly found to be helpful in treating IBS,
has been shown to have profound effects on improving
microbiota diversity and in shifting the composition toward
less pathogenic strains 3,4
Dosing:
VSL#3, 225 billion CFU daily-BID
Multiple strains of Bifidobacterium and
Lactobacillus, 20-40 billion CFU, daily to BID
Recommend trial for 4-8 weeks, can
then try decreasing dose
1. Didari T et al. World J Gastroenterol. Mar 14 2015. 2. Ford AC et al. Am J Gastroenterol. Oct 2014. 3. Moayyedi P, et
al. Am J Gastroenterol. Sept 2014. 4. Simpson HL, Campbell BJ. Aliment Pharmacol Ther. Jul 2015.
16. Obesity
Multifactorial process
In setting of stable energy consumption and adequate
physical activity – prevalence of metabolic disorders is
rising
Animal data showing that the microbiota of obese rats
cause weight gain in settings of controlled calorie intake
Mechanism is thought to be through increased calorie break down and
absorption
Recent Meta-analysis of 4 RCT’s showed no difference in
those treated with probiotics for weight loss
2 studies not included for poor description of randomization were
longer and with higher doses of probiotics showed positive results
Possible that future studies will with higher concentrations and better
control for diet will show better results
Park S, Bae JH. Nutrition research (New York, N.Y.). Jul 2015.
17. Diabetes
Hypothesis is that dysbiosis of the gut flora
Activation of pro-inflammatory cytokines
Disruption of the intestinal mucosa
Leading to systemic inflammation and glucose dysregulation
Probiotic supplementation studies are showing largely beneficial
effects on glycemic controls especially in animal studies.
The largest systematic review to date looked at 33 studies of
which 5 were in humans.
All of the studies in humans showed a significant reduction in at
least one parameter of glycemic control
It is still unclear which strains confer the most benefit and if
those benefits are sustainable without dietary and activity
changes.
Le Barz M, et al. Diabetes & metabolism journal. Aug 2015. Tarantino G, Finelli C. Future microbiology. 2015. Samah S, et al. Diabetes Research
and Clin Pract. Aug 2016.
18. Hot Flashes – Non biological
therapies
CBT
Several small RCT’s show decrease in problem rating
although not in frequency1
Yoga
Several RCT’s show improvement in hot flashes as well as
insomnia, mood disturbances, irritability and anxiety1,2
Acupuncture
Meta-analysis level data show improvement in hot flash
frequency and severity as well as improvement in QOL3
1. "Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The
North American Menopause Society." Menopause 2015. 2. Crowe BM, et al. Health care for women international.
2015. 3. Chiu HY, et al. Menopause. Feb 2015.
19. Hot Flashes – Biological therapies
Soy Isoflavones
Meta-analysis level data show statistically significant reduction
in frequency of hot flashes but no change in the Kupperman
Index (11 menopausal related symptoms)1,2
60-90mg a day of Isoflavones (average dose studied)
S-Equol – intestinal bacterial metabolite of soy
30-40mg S-Equol decreased vasomotor symptoms in small RCT3
Pycogenol – lignand from Maritime Pine Plant
Two small RCT’s show decrease in vasomotor symptoms and
improvement in sleep4
Linseed/Flaxseed – Isoflavone with less estrogenic effect
than soy
1 g of either extract or meal shoed decrease in vasomotor
symptoms in small RCT5
1. Chen MN, et al. Climacteric : the journal of the International Menopause Society. 2015. 2.
Taku K, et al. Menopause 2012. 3. Utian WH, et al. Journal of women's health. 2015. 4. Kohama
T, Negami K. Journal of Reproductive Medicine. 2013. 5. Colli MC, et al. Journal of medicinal food.
2012.
20. Therapies Commonly Used in
Integrative Medicine
Mindfulness
Elimination Diets
Acupuncture
21. Mindfulness
Growing evidence on mindfulness impacting QOL in
almost all chronic diseases
Evidence:
Improved coping with pain
Decreased anxiety/depression
Improved relapse prevention in substance abuse
Eating disorders
Improved glycemic control in diabetes
Vasomotor symptom
22. Mindfulness Based Stress
Reduction
8 week course
2.5 hours per week with home practice
Includes instruction on mindfulness, stress and its impact
on body
Practice/teaching of mindful awareness practices, walking
meditation, simply yoga postures
First developed by Jon Kabat-Zinn, PhD at University of
Massachusetts and applied at first to patients with
chronic pain1
Now adapted into many other programs based on
individual disease being treated
1. Kabat-Zinn J. General hospital psychiatry. 1982.
23. Elimination Diets
Removal of offending food from diet, assessment of
symptoms, challenge with offending food if symptoms
had improved to assess for recurrence
Theory behind causation is evolving
Foods that are not tolerated cause inflammation in the gut
lining leading to gut wall breakdown and protein
translocation leading to antibody development
The inflammation itself leads to dysbiosis of microbiome
Common starting point is removal of 5 most allergenic
foods
Wheat/gluten, dairy, soy, corn, eggs
3-4 weeks off food
Re-introduce with assessment of symptoms
24. Elimination Diet
Allergic/dermatitis
IBS/ chronic abdominal pain
FODMAPS
Fatigue
Possibly related to improved nutrition/lower glycemic index
Chronic Pain
Fibromyalgia1
Migraines
Small RCT for patients with migraines and IBS2
1. Rossi A, et al. Clin Exp Rheumatol. 2015. 2. Aydinlar EI, et al. Headache. 2013.
25. Acupuncture
Growing evidence:
Chronic Pain1,2
Chronic Musculoskeletal Pain
Fibromyalgia
Osteoarthritis
Chronic Back Pain
PMS/Menopausal symptoms3
Chronic Fatigue4
Fertility5
1. Vickers AJ, et al. Archives of internal medicine. 2012. 2. Manyanga T, et al. BMC
complementary and alternative medicine. 3. Chiu HY, et al. Menopause 2015. 4. Kim JE, et al.
Trials. 2015. 5. Nandi A, et al. Journal of obstetrics and gynaecology, 2014.
26. Resources
Pub Med & Google Scholar
Natural Medicines & Consumer Labs
https://naturalmedicines.therapeuticresearch.com/
https://www.consumerlab.com/
University of Michigan – Educational Modules
https://sites.google.com/a/umich.edu/fammed-modules/
University of Wisconsin – Educational Modules and Patient
Handouts
http://www.fammed.wisc.edu/integrative/resources/modules/
Integrative Medicine by David Rakel, MD
Editor's Notes
Up to 10% of an individual's daily energy needs can be derived from the byproducts of bacterial fermentation.
prevent colonization by pathogens by competing for attachment sites or for essential nutrients.
antagonize other bacteria through the production of substances which inhibit or kill nonindigenous species. The intestinal bacteria produce a variety of substances ranging from relatively nonspecific fatty acids and peroxides to highly specific bacteriocins, which inhibit or kill other bacteria.
Vitamins - in humans, enteric bacteria secrete Vitamin K and Vitamin B12, and lactic acid bacteria produce certain B-vitamins. Germ-free animals may be deficient in Vitamin K to the extent that it is necessary to supplement their diets.
Modulate immune function - Several species induce protective cytokines (IL 10, TGF-β), and suppress proinflammatory cytokines including TNF, in the mucosa of patients with pouchitis, ulcerative colitis, and Crohn’s.
S. boulardii limited migration of T-helper 1 cells in inflamed colon tissue in mouse model with IBD
altering secretory immunoglobulin A levels, decreasing inflammatory effects of natural killer cells, and trapping helper T cells in mesenteric lymph nodes to decrease the inflammatory response
Problems when imbalance: some of the bacteria in the colon (e.g. Bacteroides) have been shown to produce metabolites that are carcinogenic, and there may be an increased incidence of colon cancer associated with these bacteria. Alterations in the GI flora brought on by poor nutrition or antibiotics can shifts in populations/colonization causing GI disease.
probiotics may also be effective for treatment of constipation in adults (less evidence for kids)
Consider adding prebiotic, particularly if constipation dominant
Recommend a mixture of 50/50 L. plantarum with B. breve at 25 billion colony-forming units (CFUs) twice daily for 6 to 8 weeks; then decrease to 10 billion CFUs/day.
Moayyedi P, , et al. Gut. 2010 Mar;59(3):325-32.
Hoyeyda et al, BMC Gastroenterol. 2009 Feb 16;9:15.
Guandalini S, et al. J Pediatr Gastroenterol Nutr. 2010 Jul;51(1):24-30.
Ringel-Kulka T, J Clin Gastroenterol. 2011 Jul;45(6):518-25.
Silk D, et al. Aliment Pharmacol Ther 2009 Mar 1;29(5):508
randomized crossover trial, 67 children aged 5-18 years with IBS had 2 week run-in then randomized to VSL#3 (1 packet daily to BID) probiotic vs. placebo for 6 weeks followed by 2 week washout then crossed over
59 children (88%) completed trial and analyzed
VSL#3 probiotic associated with significant reduction at 2-6 weeks in symptoms
abdominal pain
abdominal bloating/gas
life disruption (family assessed)
