THERAPEUTICS WITH NATURAL REMEDIES - HIOM Therapuetics with Natural Remedies_ F… · THERAPEUTICS...
Transcript of THERAPEUTICS WITH NATURAL REMEDIES - HIOM Therapuetics with Natural Remedies_ F… · THERAPEUTICS...
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THERAPEUTICS WITHNATURAL REMEDIES
Stephen Holt MD, LLD (Hon.) ChB., ND, FRCP (C), MRCP (UK), FACP, FACG, FACN, FACAM
Distinguished Professor of Medicine, NYCPM
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HISTORIC PERSPECTIVES
• Pharmacognosy: the study ofnatural products used in medicine
• Ancient discipline of medicalscience
• Pharmakon = drug, Gnosis =knowledge
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CONCEPTS• Natural medicine cannot integrate into
general medical practice without ascientific base
• Botanicals or herbs are “drugs” andmany drugs are botanicals or herbs, orsynthetic copies
• Dietary supplement manufacturersexhibit widespread ignorance aboutpharmaceutical science
• Hiding behind mythical and magicalthinking is no longer acceptable inintegrative medicine
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CONCEPTS• Some natural clinicians baulk at attempts
to explain the bioactivity of naturaltherapies within the framework of currentscientific knowledge
• While sympathy exists for this position,our understanding of pharmacodynamiceffects of herbs, botanicals or nutrientsmust be based on scientific principles
• Conversations about clinicalpharmacology among dietary supplementmanufacturers are rare and practicallynon-existent with their customer base
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DRUG OR NUTRACEUTICALDISPOSITION
• If dietary supplements are to be used astherapeutic agents, there must be somerespect for basic pharmacologic concepts.
• The concepts are A, D, M and E• One may look critically at some dietary
supplements by simply consideringfactors that influence absorption,distribution, metabolism and excretion ofchemical compounds [drugs ornutraceuticals]
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ABSORPTION• Absorption is a complex function of route
of delivery, chemical characteristics,processes of movement acrossabsorption barriers and physiologicalevents such as gastric emptying, ormodified by presence of disease, age etc
• Some nutraceuticals claim that they haveabsorption and bioavailability that cannotbe present, based on simple scientificprinciples
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ABSORPTION [examples]• FISH OIL: Unstable in regular
formulations, denatured by gastric acid,power is with EPA. Dosage requirementshigh, compliance issues, triplebioavailability with enteric coat.Standard fish oil products passe
• SHARK CARTILAGE: solid or extract,enzymatic degradation of antiangiogenicproteins, buccal absorption a “fairy tale”,interesting facilitated absorption by aleaky gut
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DISTRIBUTION• Drug distribution is often uneven:
different tissue binding, different PH orpermeability of tissues
• Example: Antioxidant Therapy: Idealantioxidant has lipophilic and hydrophilicprofiles and acts in a wide REDOX range
• Single high dosage antioxidants havedangerous pro-oxidant effects eg vit.C, E
• Most antioxidant supplements do not usethe correct principles of formulation
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METABOLISM• The process of chemical alteration of
drugs in the body• A primary but not exclusive function of
the liver• Inactive and active metabolites are
produced, by synthetic or non-syntheticreactions
• Example: Isoflavones: genistein/genistin,conjugation eg daidzein sulfate. Acomplicated story
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EXCRETION• Elimination from the body, primarily by
the kidneys• A real concern exists with age related
reduction in renal function andnutraceutical dosage adjustment
• Some complex mechanisms exist egreabsorption transport mechanisms,tubular secretion and biliary excretionwith enterohepatic cycling
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GENERAL ISSUES• Dietary Supplements are the main stay of
alternative and complementary medicine
• Growth overall in OTC sales
• Contemporary switch to natural remedies
• The natural remedy “first line option” aswell as the “last line option”
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DSHEA- BASED MODEL• WEAK SUPPORTING
DATA
DIETARY SUPPLEMENT
? CREATE PLATFORM
SELL WITH “CLAIM”
PEER ACCEPTANCE
SUCCESS FAILURE
• STRONG R & D
“PRODUCT” AS A DIETARYSUPPLEMENT
BODY STRUCTURE FUNCTIONCLAIM
PEER ACCEPTANCE
SELL (PHASE IV AND V)
SUSTAINED
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A PEEK INTO THE “INDUSTRY”• The product of the month• The evidence based formula• Condition specific formulations• CEO survey reveals scientific-
based, new formulations are ofmajor importance
• Who formulated the supplementsyou use in your practice?
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KEY PUBLIC HEALTHINITIATIVES
• Lifestyle medicine combined withnutritional interventions haveovershadowed allopathic approachesfor many public health problems
• First line options for diseaseprevention are not rooted generally indrugs or surgery
• Many factors have moved consumersof health care to the new paradigm ofsimple, gentle and more “natural”interventions
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KEY PUBLIC HEALTHINITIATIVES
• Adult obesity• Childhood obesity (A Dead-Loss
Disorder)• Cardiovascular health• Cancer• Arthritis• Osteoporosis
THERE MUST BE A CONDITION SPECIFIC APPROACH
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THE KEY PUBLIC HEALTHINITIATIVE
• The metabolic syndrome(SYNDROME X)
• A complex disorder rooted ingenetics, adverse lifestyle withprimary nutritional precipitation
• Defining Syndrome X
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THE PUBLIC HEALTH RISK
• Syndrome X increases risk for : Maturity Onset Diabetes Mellitus Cardiovascular Disease Cardiovascular Deaths Deaths from ALL CAUSES
Am.J.Epidemiol, 148, 958, 1998.
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SYNDROME X : THERAPEUTICS
• Soluble fiber eg oat beta glucan hydrocolloid• Soy Protein 25 g/day• Omega 3 fatty acids (EPA)• Chromium• Alpha lipoic acid• Vanadium• Antioxidants eg ellagic acid, bioflavonoids• Starch blockers• Cinnamon• Maitake• Green coffee bean extract• Hoodia gordonii
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LOWERING CHOLESTEROL
• When the treatment is worsethan the disease
• Diet• Exercise• Aggregate benefits of Soluble
Fiber, Soy Protein, Omega 3fatty acids, Garlic, and others[synergy]
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WEIGHT MANAGEMENT
• A holistic management approach that isbest undertaken by a practitioner ofintegrative medicine
• Multifactorial causes requiringmultipronged approaches
• Weight loss must not be the sole target formanagement. HOODIACY?
• The real issue is obesity related disease,disability and death
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DIETARY SUPPLEMENTS AS APROFIT CENTER
• Declining revenue for cognitive activity inclinical practice
• Dietary supplement dispensaries are a majorprofit center
• Supplement sales promote return visits andprecipitate spontaneous demands frompatients for disease prevention
• Margins on sales are high• Supporting literature saves consultation time• Avoid any unethical relationships with
supplement purveyors
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ETHICS• Physicians must not engage in self
referral• Private labels with physician identity
are problematic [legal liabilities]• State licensing authorities have mixed
beliefs about supplement sales• At law, dietary supplements are not to
be used to prevent or treat any disease• Medical practice should not be
legislated
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CONCLUSION• The interface between alternative medicine
and allopathic medicine is increasinglyindistinct
• At least three quarters of all patients in anout-patient, hospital, clinic are takingsupplements, some of which are worthless
• A doctor who sells a dietary supplementthat is available in retail will ruin theirpractice [A HUGE ISSUE]
• Supplement dispensation by healthcareprofessionals will lead to the responsibleuse of dietary supplements