Transcript Clinical Pearls - Trinity Family Health Clinic, Seattle

Clinical Protocols
David B. Wood, ND
B.Sc. Microbiology, University of Washington, 1977
N.D., Bastyr University, 1983
Cofounder, President: Trinity Family Health Clinic, PS, 1984
Cofounder, Vice President, CMO: BioGenesis Nutraceuticals,
Inc., 2000
Introduction
In this lecture I will review my thoughts in terms of
physical exam, laboratory and therapeutic options for
various conditions I see in my office.
I will discuss the why’s and dosage’s of nutraceutical
and botanical Rx options
This lecture is not meant to be inclusive but rather a
primer to encourage thought and discussion as well as
an aide in your own decision making process.
Allergies (Food)
R/O with laboratory testing (IgG) or Elimination/Challenge diet.
This is a good time to do the BioCleanse Detox program.
Avoid 2+ or higher foods, Rotate others
Desensitise with homeopathic dilutions of allergens (Apex) or T
cell balance with Sterol 117 (1-2 QD)
Run Digestive/Microbiol/P testing, Organix or Lactulose/Mannitol
testing to assess level of gut dysbiosis, permeability and/or
digestive enzyme deficiencies
Allergies (Food)
Remove any bowel pathogens with ParaBiotic Plus (2 TID)
Consider reforestation of bowel: ProFlora Plus (2 BID).
Initiate this treatment after completing ParaBiotic Plus phase.
Repair mucosal barrier/gut lining with: Intestinal Repair Complex
(1 tsp BID-TID) or Intestinal Repair Capsules (2-3 TID)
Allergies (Environmental)
Seasonal?
– Late February to Mid April? Probably Deciduous Tree
Pollens
– Mid April to Mid July? Probably Grass/Weed pollens
– Year around? Probably dust mite or mold allergy
Evaluate symptomatically or allergy test with IgE serum testing or
skin testing.
Allergies (Environmental)
Reduce exposure (air cleaners, electrostatic
precipitators, etc.)
Desensitise with Sterol 117 (T-cell balancing) (1-2 QD)
Rx: BioAllergy Plus capsules (2-4 caps TID - QID
between meals)
Rx: Immune Balancing Complex (T cell balancing)
(1-2 BID with food)
Adrenal Insufficiency
Check for postural hypotension (Lying to
standing blood pressure evaluation).
I consider it significant if the systolic
pressure drops by 8 points or more.
Serum Sodium less than 140. My
optimal is 140-142
Test Salivary Hormones to check for
deficiency and/or circadian rhythm
disturbances.
Fatigue after exercise and history of
slow recovery. Takes 2-3 days to
recover from stress, exercise, etc.
23-3: The control pathway for cortisol
CourtesyFigure
of Felix
Grissom, PhD.
Paper entitled “The Adrenal Gland”
22
Ideal Adrenal Circadian Rhythm
*
*
15
10
*
*
0
8am
12
4
8pm
12
* Abnormal Serum/Saliva Cortisol Readings
Adrenal Insufficiency
Rx: BioAdaptogen 1-2 capsules up to TID between meals
Rx: BioAdreno 2 with breakfast and 1 with lunch. Do not give
later in the day.
Rx: Adreno Support Plus 2 BID (contains DHEA, Pregnenolone)
Rx: Celtic salt to replace regular table salt (to taste)
Rx: Adreno HS-SOD 2-4 capsules before bed to enhance HPA
axis regulation and reduce excess evening cortisol
Rx: Zone balanced regular meals. UltraLean (powder and bars)
or UltraPure Whey protein to assist (1SVG/day)
Rx: Stress reduction, gentle exercise
Anti-Aging/Longevity
AGEx (2 BID) for antiglycation, antilipofuscin and
antioxidant cellular protection
Oxy ATP (1-2 BID)
MultiGreens (2 BID)
Work on low glycemic diet, exercise, stress reduction,
hormone balancing, optimize immune system, digestive
and elimination support, dental and intestinal hygiene,
detoxification. Cardio evaluation and treatment.
Cancer prevention and screening.
Arthritis
R/O DJD vs. RA
– exam
– family history
Zone Balanced Diet
Osteoarthritis
w/Heberden’s
nodes
Gouty
Arthritis
Rheumatoid
Arthritis
w/Bouchard’s
nodes
Arthritis
Rx:
– ArthroGenX capsules (2-3 TID with meals)
– ArthroGenX cream (topical BID – TID)
– PainX capsules (2-4 BID-TID)
– BioInflammatory Plus Functional Food (1 Svg/day)
– EPA/DHA (2-3 BID with meals)
– OsteoGenesis regular or E.S. (2 TID with meals)
Labs recommended:
– Organix or Digestive/Microbiol/Parasite
– Allergy evaluation (Elimination/Challenge, IgG)
– Urine/Saliva pH screen (r/o acidosis)
– serum autoantibodies (if unsure)
Autoimmune Disorders
Run labs to further assess patients nutritional needs:
– Organix (MM) or MAP (GSDL)
– Allergy (IgG or Elimination/Challenge)
– Zinc Tally taste test
– Postural Hypotention Adrenal Insufficiency Screen
– urine/saliva pH
Correct Dysbiosis
– (ParaBiotic Plus, ProFlora Plus, Intestinal Repair Complex)
ParaBiotic Plus and IRC can be given together. ProFlora Plus
caps should be started after completing the prescribed
course of ParaBiotic Plus or given for 1-2 months past
completion of ParaBiotic Plus
Autoimmune Disorders
Treat T Helper 1/T Helper 2 cell imbalance:
– (Sterol 117 (1-2 QD), Immune Balancing Complex (1-2 BID) )
– Quench Inflammatory Mediators and assist in balancing Phase
1/Phase 2 detoxification pathways:
– (BioInflammatory Plus Functional Food, BioInflammatory Plus
capsules, ArthroGenX, PainX, EPA/DHA)
Breast Disorders
CRT (Computerized Regulation Thermography) testing to further
define breast cancer risk
Evaluate 2OH E1/16alphaOH E1 ratio (risk factor)
Breast exam
Mammogram/Breast Ultra Sound/Biopsy (if warranted)
In Breast Cancer
often the lump will be
attached to the chest
wall
Look for dimpling of
the skin (retraction of
skin on bending
forward)
Color changes of the
overlying skin
Breast Disorders
Hormone balancing: often reduction of estrogen dominance
symptoms.
– BioCleanse powder detox for 2 weeks followed by ongoing
use of BioCleanse caps (Calcium D-Glucarate, Broccoli
extract) (2 BID to TID) (Glucuronidation, Aromatase)
– BioIsoflavone caps (Soy Isoflavones)
– DIM PRO PLUS (FIT) (1 BID) (Aromatase)
– EPA/DHA (2-3 BID with meals)
– Lipopure Progesterone especially if patient also has PMS,
uterine cramping, and/or heavy prolonged menses (dosage
varies, 5-20 gtts BID topical (rotate sites) or oral)
CFIDS
R/O the basics: anemia, clinical or subclinical hypothyroid (labs
+ temps), hypoglycemia, circadian rhythm disorders
(sleep/melatonin, adrenal hormones/postural hypotension),
deficient mitochondrial energy production, chronic virus (EBV,
CMV), pleomorphic organism (Chlamydia pneumoniae,
Mycoplasma fermentens), intestinal dysbiosis, allergy/leaky gut,
T Helper 1/T Helper 2 imbalance, depression.
CFIDS
Clean up the diet (Zone balanced whole foods) and establish a
routine
– often patient eats on the run. Eats fast food. Doesn’t eat on
a schedule
Rx: depending on findings
– Possible use of: (BioCleanse Functional Food, BioAdreno,
Adrenal Support Plus, BioAdaptogen, RiboZest, Lipopure
Melatonin, GlucoTone, MycoPotent Immune Complex,
Immune Balancing Complex, ParaBiotic Plus, ProFlora Plus,
UltraHematinic, Sterol 117)
Cholesterol/Triglyceride Elevation
Cardiovascular Occlusion
Diet: Low fat, high fiber. Zone balanced. Whole
foods. Variety of fresh fruits/vegetables.
Exercise: 3-5 x/week combination cardio/weights.
Duration/intensity according to doctors
instructions
Labs: VAP (Lipid panel with LDL particle size and
lipoprotein (a)), Fibrinogen, Homocysteine,
Cardio CRP, cIMT (carotid ultrasound intimal
thickness), EBT (Electron Beam Tomography) to
rule out pathologic calcification of the arteries),
Nanobacterial serology, C. pneumoniae serology.
Cholesterol/Triglyceride Elevation
Cardiovascular Occlusion
Rx’s:
General:
BioLipotrol (2 TID) or (3 BID) lower dosage if
mild elevation.
Garlic 7000 (1-2 BID)
Functional Food (if needed): BioCleanse or
UltraLean (meal replacement)
Cardiovascular Occlusion:
Cardio Complete (5 – 10 QD-BID)
Liposomal EDTA (2 tsp twice weekly to once
daily)
Cognitive Dysfunction
Patient complains of Simple Memory
disorder (short term)
Zone balance diet to protect against
hypoglycemic short term memory
loss
CogniFactors (1-2 capsules BID)
BioFocus (1 SVG/day)
Ginkgo Select 120mg (1 BID)
Contraindicated if patient is on
anticoagulant Tx.
(Coumadin/Warfarin)
AD brain, Red = areas of
degeneration
Cognitive Dysfunction
EPA/DHA (2-3 BID with meals)
R/O anemia, hypothyroid, elev. Homocysteine,
atherosclerosis (lipid panel)
Anemia: UltraHematinic (1 TID with meals)
Hypothyroid: BioThyro or MetabolStim (vegetarian) 2
caps QD-BID without food and possible Rx natural
‘Armour’ thyroid medication
Homocysteine: Ultra B Complex 1-2 QD with meals
Elevated Lipids: BioLipotrol 2-3 BID to TID with meals
Colon Disorders
(IBS, Colitis, Crohn’s)
Labs:
Organix (urine) or Digestive/Microbiol/Parasite (stool)
Allergy (IgG and/or Elimination/Challenge)
Hemocult (if DMSP above not done)
Colonoscopy (if indicated)
Colon Disorders
(IBS, Colitis, Crohn’s
Physical Exam:
Remember to perform Auscultation, Palpation
and Percusstion of the abdomen AND check for
referred pain from other locations (back –see
dermatome chart, Upper GI (stomach,
liver/gallbladder, pancreas), lower pelvic organs,
valves (pyloric, ileocecal), appendix, etc.
Colon Disorders
(IBS, Colitis, Crohn’s
Rx:
Intestinal Repair Complex powder or capsules – (1tsp BID to TID
or 2-3 capsules BID-TID)
Intestinal Rejuvenex – (2 scoops QD to BID)
Vitamin E 400 1-2 QD to TID (high levels can be used to
enhance SIgA production in patients with low levels. Also Dr.
Bastyr recommended to stop bleeding within 4 days!)
UltaPure Whey protein - 1-2 SVG/day (if tolerant to Whey) good
source of glutamine and very high in immunoglobulins
Ultra Fiber Plus (1 svg/day)
Detoxification (Heavy Metals)
Assessment: Urine/Blood Toxi HMF Challenge or Hair
Elements Analysis. HCA (www.holisticprotocols.org)
indications of environmental or drug toxicity. In office
screens – high probability score on multisymptom
questionaire or S.O.S. questionaire.
Typical Rx’s:
– Liposomal EDTA 2 tsp 2 times per week to once daily
– Toxi HMF 2-3 capsules BID w/o food
– BioCleanse Functional Food: – follow BioCleanse
diet/dosage recommendations in handout or ½ to 1
SVG/day for longer duration of time (1-3 months)
Detoxification (Heavy Metals)
Rx’s continued:
– BioAlkalizer 1 –2 tsps daily (Green food chelator)
– UltraPure Whey protein: 1 SVG/day (Glutathione
and Metallothionine production)
Detoxification (Heavy Metals)
– Possible dysbiosis treatment, intestinal reforestation and
intestinal repair (ParaBiotic Plus, Dysbioplex FNG, ProFlora
Plus caps, Intestinal Repair Complex)
– Encourage exercise, pure water to hydration, adequate
sleep, blood sugar balance through regular balanced
(40/30/30), organic food based meals and stress reduction
(prayer, meditation, Heart Math, etc.)
Fibromyalgia
R/O conditions such as:
acidosis (urine/saliva pH),
allergies,
blood sugar dysregulation,
electrolyte imbalance (serum, calf cramp challenge testing),
EFA deficiencies (repetitive stress muscle test),
infection (approx. 50% or our patients show + to CMV),
soft tissue calcification
Fibromyalgia
Dx requires 11+/18
tender points
These points are for
diagnosis. Your patient
may have many other
tender points!
Note degree of pain mild, moderate or severe
Monitor at each visit to
note progress.
Fibromyalgia
Most common Rx’d supplements:
– Rx: Super FMS (1-2 per meal)
– Rx: PainX (2-4 caps BID – TID)
– Rx: Muscle Aid (1/2 to 1 teaspoon twice daily)
– Rx: BioInflammatory Plus Functional Food (1 SVG/day)
• and encourage a zone balanced diet
– Rx: OsteoGeneis ES (1-2 per meal) (if serum calcium less
than 9.0, and calf cramp test less than 200 (goal 200-240
with no cramp)
– Rx: EPA/DHA (2-3 twice daily with food)
GERD
R/O: hypo/hyperchlorhydria, Helicobacter pylori, food allergy
If acids aggravate: Avoid (vinegar, caffeine (coffee, chocolate,
colas, black teas), tomatoes, citrus, alcohol, spicy foods, high fat
foods)
If acids ameliorate: Encourage
– apple cider vinegar (1 tsp in glass of water with meals) to
aide digestion
GERD
Fiber provides bulk and
weight in the stomach to
help reduce reflux
Rx:
Ultra Fiber Plus 1-2 Svg
per day
GERD
Rx:
Gastric Repair Complex (chew or swallow) 2
capsules with meals and before bed (contains
Mastic Gum – supports H. pylori eradication)
Intestinal Repair Complex 1 tsp BID to TID
Para Biotic Plus (if extra help needed for + H.
pylori) 2-3 TID for 1 month followed by:
Proflora Plus 2 BID for 2-3 months
Headaches
Diet: Hypoallergenic, zone balanced
Exercise: 3-5 x/week, combination cardio/weights
Rx’s:
Muscle Tension:
Muscle Aid (1 tsp BID) or Tri Mag (1 BID with meals, according to
bowel tolerance)
PainX 2-3 PRN
OsteoGenesis ES (2 TID with meals)
Headaches
Migraine/vascular:
MigraClear Ultra (1 TID)
PainX (3-4 TID) PRN
OxyATP (1 TID)
EPA/DHA (2-3 BID)
Sinus Headache:
BioAllergy Plus (2 QID between meals and before bed)
PainX (2 QID) PRN
NAC (MM) (1-2 BID between meals)
Euphorbium (Heel) or QC (Th) nasal spray
Nasal rinse with ProFlora Plus caps
Heart Disorders
Cardiac Arrhythmia:
UltraCardio (2 BID-TID with
meals)
Secondary Support:
Muscle Aid (1 tsp BID)
Taurine (MM) (1-2 BID)
EPA/DHA (2 BID)
Vitamin E 400 (1-2 QD with a
meal)
OxyATP (mitochondrial support)
(1 BID with meals)
Heart Disorders
Mitral Valve Prolapse:
TriMag (1 per meal)
Hypertension:
Cardio HTN (1-2 caps BID)
Garlic 7000 (1 TID with meals)
TriMag (1 TID with meals
according to bowel tolerance)
OsteoGenesis ES (2 TID with meals)
Heart Disorders
Cardiac weakness/fatigue (myopathy, CHF)
– UltraCardio (2 TID)
– RiboZest (1 tsp BID)
In cardiomyopathy r/o viral etiology and treat if (+)
In CHF diuretics may also be necessary
Herpes/Viral Infection
Diet: Low sugar, low arginine,
high lysine. Reduce intake of
peanuts and chocolate
Rx:
LarreaRx (UpLife) 1-2 caps BID
LarreaRx (UpLife) Lotion
(topical) or
LarreaRx penetrating Spray
(topical) TID
Immune Enhancement
Diet: Low in sugar, hypoallergenic, zone balanced
Exercise: 3-5 x/week. Combination cardio/weights
Stress reduction: set goals, prioritize, prayer,
meditation, good sleep and eating habits, work on
communication skills, organize
Possible Rx’s:
Lipopure Melatonin oral drops (enhancement of thymus
& sleep cycle)
– 10-30 drops sublingually before bed nightly
Immune Enhancement
MycoPotent Immune Complex (20-30 gtts QD)
Immune Balancing Complex (2 caps BID)
ImmunoGlucan (UpLife) (1-2 BID)
Currently sick?:
BioPotent C (2 caps BID)
ImmunoGalactans (1/2 –1 tsp QD)
PhytoImmune (3-4 TID) viral
ParaBiotic Plus (2-3 TID) bacterial/fungal
Menopause/Perimenopause
Zone balanced hypoallergenic diet
Cardiovascular protection:
– Ultra CoQ10 100 1 QD, OxyATP 1 QD, Vitamin E 400 1 QD
with meals
Bone loss protection:
– OsteoGenesis or OsteoGenesis ES
Labs: Bone Loss Resorption (NTx urine), DEXA scan
Natural HRT:
Lipopure Progesterone 15-30 gtts BID (oral or topical)
BioIsoflavone 1 BID - TID or
BioFem HRT 1 BID - TID
Lab: Estronex 2OHE1/16OHE1 (urine), salivary or serum
Est/Progest and FSH
Osteopenia/Osteoporosis
Labs: Bone Resorption (N-Telopeptide) (urine), Bone density (Dexa
Scan)
Weight bearing exercise
HRT (if indicated: low or menopausal)
– Lipopure Progesterone 15-30 gtts BID (osteoblast enhancement)
– BioIsoflavone 1-2 BID (osteoblast enhancement, osteoclast
inhibition)
Soluble minerals and bone specific collagen for
remineralization/remodeling of bone matrix
– OsteoGenesis (2-3 TID) or OsteoGenesis ES (2-3 TID) does not
contain MCHC
– Vitamin D3 1000 (1-2 QD)
UltraGest (if low stomach acid) 1-2 TID mid to end of meals
UltraLean Functional Food (if overweight or needs help in improving
Osteopenia/Osteoporosis
Botanicals
– Horsetail 2-3 capsules BID.
Rich in bone and connective
tissue building silicon
– Nettles 2-3 capsules BID.
Rich in Magnesium and
silicon.
Premenstrual Syndrome
Diet:
Zone Balanced, hypoallergenic, low in sugar, caffeine
Evaluate hormone status: (often a progesterone deficiency)
BioFem PMS 2-3 caps TID –BID (days 11-25, occ to day 3 of cycle)
Lipopure Progesterone 15 gtts BID days 11 - 25. Depending on the
severity of the PMS, I may have patient start earlier than day 11.
Other common Rx’s:
StressX (1-2 PRN, QD – QID) for mood stability, and healthy sleep
enhancement
Ultra B Complex 1-2 BID (coenzyme form for greater biological activity)
TriMag 1-2 BID
UltraLean Functional Food 1 SVG/day
Prostate Disorders
PSA laboratory testing. Blood draw before digital exam
Physical exam of gland (DRE)
Benign: Rx
BioInflammatory Plus Functional Food for 2-3 weeks to detox
and determine any possible food intolerences
BioProstate 1-3 BID
EPA/DHA 2-3 BID
Sterol 117 1-2 QD
Vitamin D3 1000 1-2 BID
Prostate Disorders
Rx: Malignant: Above recommendations as well as:
– Proteolytic enzymes: BioPan or Vegizyme
– Immune enhancers: MycoPotent Immune Complex
and Immune Balancing Complex, ImmunoGalactans,
Pulsed antioxidants (if on chemotx or radiotx
treatment) OxyATP, Green Tea, BioPotent C,
MultiGreens
– Anti-metastatic agents: Fractionated Pectin (Th),
Turmeric (Curcumin) such as: BioInflammatory
capsules
Further Information
BioGenesis Nutraceuticals, Inc.
– 1.866.272.0500
David B. Wood, ND
– 425.778.5673
– [email protected]
– [email protected]