IntegrativeMedicine GeneticsandLifestyleforCognitive

HealthInstituteforIntegralHealth,LLC

MaryAnnOsborne,DNP,FNP

Objectives● DiscusstheAPOEGeneandit’slinktochronicdisease

● Demonstrateknowledgeoflifestyleandbrainhealth

● IdentifythesubtypesofAlzheimer’sDisease

● DiscussissueswithcaregiversofAlzheimer’sclients

MyJourney● Near-Deathexperienceatage7

● HolisticBSNprogram

● JoinedArmyNurseCorps

● ArmyNursePractitioner–1986(AdultNP)

● Master’swithcommunityfocus–1991(FNP)

● IntegrativeMedicineFellow–2003

● DoctorofNursePractice–2010

● IndependentPractice-2005

TippingPoint

Personal&FamilyCrisis

PrograminIntegrativeMedicine● UniversityofArizonaSchoolofMedicine

● 1994IMFellowship–Residential

● 2000ResidentialandHybridDistance

● 20031stNursePractitionergraduated

● AnnualNutritionandHealthConference

● Onlineprograms,IntegrativeHealthLifestyleprogram

(IHeLp),IntegrativeHealthCoaching

● FreeEnvironmentalHealthcourse

● Integrativemedicine.az.edu

IntegrativeMedicine● Ishealing-orientedmedicinethat

takesaccountofthewholeperson

(body,mind,andspirit),including

allaspectsoflifestyle.

● Itemphasizesthetherapeutic

relationshipandmakesuseofall

appropriatetherapies,both

conventionalandalternative.

Dr.AndrewWeil

PrinciplesofIntegrativeMedicine● 1.Apartnershipbetweenpatientandpractitionerinthehealingprocess.TwoExperts

2.Appropriateuseofconventionalandalternativemethodstofacilitatethebody'sinnatehealingresponse.

3.Considerationofallfactorsthatinfluencehealth,wellnessanddisease,includingmind,spirit

andcommunityaswellasthephysicalbody.

PrinciplesofIntegrativeMedicine● 4.Aphilosophythatneitherrejectsconventionalmedicinenoracceptsalternativetherapiesuncritically.

● 5.Recognitionthatgoodmedicineshouldbe

basedingoodscience,beinquirydriven,andbeopentonewparadigms.

6.Useofnatural,effective,less-invasiveinterventionswheneverpossible.

IntegrativeMedicine● InaNutshell:

●Allowingtimeandspaceto

understandthepatient’sstoryand

fosteradeeperunderstandingand

connectionwithourpatients.

MyTransformation● Contemplationandreflection

● Journaling

● ExtremeSelf-Care

● SpiritualReflectionandConnection

● Relaxation;breathing,yoga,

● MindfulnessMeditation

● EnergyWork

● PhysicalActivity

● Healthfuleating

● Vitamins;MedicinalMushrooms;supplements

Hadmyupsanddownswith

dryspells

DiscoveredtheApoEGeneSolutionfor

TurningOffDisease

StateofHealthWhyknowaboutgeneticsandepigenetics?

15

LeadingCausesofDeathin1900

LeadingCausesofDeath2017● Heartdisease:633,842 •Cancer:595,930•Chroniclowerrespiratorydiseases:155,041•Accidents(unintentionalinjuries):146,571•Stroke(cerebrovasculardiseases):140,323•Alzheimer’sdisease:110,561•Diabetes:79,535•Influenzaandpneumonia:57,062 •Nephritis,nephroticsyndrome,andnephrosis:49,959 •Intentionalself-harm(suicide):4,193

● CDC2017

Problem:Confusion

MultipleFactors:Confusion● DietIndustry---FADDiets

● ADANutritionSurvey–Showed

● StockMarketChanged

● ProfitfocusedCorporations;ChangeinFarming

Practices;IncreaseinGMO’s

● FarmBill–increasefoodcaloriesfrom3200Kcalto

3500Kcalforeveryman,woman,child

WeEatEverywhere!

Genetics● Geneticcodecompletedin2003

● Genetictestingismoreaffordablethanever

● GeneticandEpigeneticresearchshowinglinkbetween

lifestyleanddisease.

Epigenetics● Physically:Epireferstothesheathofproteinsand

chemicalsthatcushionandmodifyeachstrandof

DNA.

●Malleableandfluid

● EntireamountofepigeneticmodificationoftheDNA

inyourbodyiscalledtheepigenome

● Exciting!It’sHereGenesgetturned“onoroff”

●WecancontroltheswitchwithBalanceofMind

BodySpirit

Genetics

ApoEGene

Providesatransportsysteminthe

humanbody-mainlyforfatand

cholesterol

APOEGene● ThoughttobeMainGeneofBody

Discoveredin1973byLawrenceBerkeleyNationalLab

ResearchedattheGladstoneInstituteUCSF-SanFrancisco.

Discoveredfirstfor:Type111hyperlipidemiaAPOE2/2

APOEGeneandAlzheimer’s1992-1995AllenD.Roses,MD&hiscolleaguesconnectedtheApoEGenetoAlzheimer’sDiseaseatDukeUniversity

CardiovascularDiseaseandAlzheimer’s

●Alzheimer'sandCardiovasculardisease

arebothinflammatorydiseases

connectedbythesamemarkers

ApoEGeneLongevity● ApoEGene4allele–7millionyearsago

● ApoEGene3allele–220,000yearsago

● ApoEGene2allele–80,000yearsago

Environment

●External:Includeseverythingthatsurroundsyou

●Internalspace:physical,emotional,social,

andspiritual

● Doyoulive/workinhealing

environments?

ArteryPenetrationofLDL

HeartDiseaseProgression

Alzheimer’s

●SimilarProcesstoCVD?

●ChronicIllnessindicatesinflammation

andimbalance

CognitiveDecline● 5.4millionAmericanpatients

● 30millionaffectedglobally

● 13millionAmericanby2050

● 160millionglobally

● 3rdleadingcauseofdeathintheU.S.(James,B.D.etal.

ContributionofAlzheimerdiseasetomortalityintheUnitedStates.

Neurology82,1045-1050,doi:10.1212/WNL.0240(2014)

CostofAlzheimer’sSignificant cost related to Alzheimer's estimated $259 billion in 2017.

Not included $94 billion in unpaid services to an estimated 10 Million caregivers.

An increase in Alzheimer’s disease by 47 % in 6 years

AFemaleEpidemic● 65%ofpatientsarewomen

● 60%Caregivers

● MorecommonthanbreastcancerintheU.S.

ADEpidemic

●30,000,000in2012

●160,000,000in2050●Untilnowverylittletherapeuticallytooffer

WhatCausesAlzheimers?

ConventionalAttitude “Thereisnothingthatwillprevent,reverse,orslowtheprogressofAlzheimer’sdisease.”

BredesenAttitude

Somedaysooneveryonewillknowan

Alzheimer’ssurvivor

BredesenProtocol● DrDaleBredesen

● BuckInstituteforResearchonAging,Novato,CA

● Failureofmonotherapies

● Multiplepathogenictargetsforpotentialdrugs

● Chronicillnesssignalsimbalance/inflammation

BredesenProtocol● Aroofwith36holes

● OrganismsproduceAmyloidplaqueinresponseto3

majormetabolicandtoxicdisturbances

● Inflammation(canbefrominfectionorlifestyle)

● Withdrawaloftrophicsupport(VitaminD,estradiol,

testosterone,etc)

● Exposuretotoxins(heavymetals,mercury)

● Sleepapnea,trauma,vascularinsufficiency

TypesofAD● Type1:Inflammation;APOE4gene

● 1.5Glycotoxic:insulinresistance,APOE4

● Type2:Non-Inflammatory/Atrophic;APOE4;

metabolicabnormalities;lossofhormones,vitamin

deficiencies

● Type3:Toxic;APOE4negative(usually);<65onset;

mostdifficulttotreat;causeisinfection,traumaor

LeweyBody

TypesofAD● Type4:Vascular

● Type5:Traumatic

AD● Verycommontohaveacombinationoftypes

● Forexampleglycotoxic(type1.5),inwhichthe

advancedglycationendproducts(AGEs)cause

inflammationandtheinsulinresistanceleadsto

trophicwithdrawalsignaling

● Otherinputssuchassleepapnea,trauma,andvascular

insufficiencytriggeramyloidviathesesame3major

causes.

ReCODEProtocol● Mappedthemanymolecularmechanismsofcognitive

declineandADontoatreatmentprotocol.

● Includesdozensofinterventions,beginningwith

DESS,hormonaloptimization,nutrients,targeted

herbs,brainstimulation,drugs,etc.

● Nooneinterventionclosesall36holes

● Approach:pulloutallofthestops

ReCODEProtocol● “Alzheimer’sdisease”isapathologist’sdiagnosis.This

termshouldnotbefollowedbyaperiodanymorethan

fevershouldbe—Alzheimer’sdiseaseduetowhat?

●Whatisreferredtoas“Alzheimer’sdisease”isactuallya

protectiveresponseto3majormetabolicandtoxic

insults:inflammation/infection,trophicwithdrawal,

andtoxinexposure

ReCODEProtocol● Inflammation:resolution(resolvins),inhibition,

removalofsource(s).

● Infections(chronic):Borrelia,othertick-borne,chronic

viruses,etc..

● Atrophic:optimizationofhormones,homocysteine,

methylation,trophicsupport,antioxidants,etal.

● Toxins:metalsincludingCu:Znratio,Hg;mycotoxins.

● Metabolismincludingglycotoxicity(type1.5).

● Regeneration,protection.

BasicConcepts● Identifyallcontributorstotheimbalancedplasticity

network

● Determinethedegreeofcontributiontoeachtype

● Optimizethevalueofeachabnormality

● Addressasmanyoftheabnormalitiesaspossible,the

earlierintheprocessthebetterchanceforsuccess

● Designthetreatmenttobeasphysiologicaland

upstreamaspossible

● Personalize

RiskFactors● Sleepapnea

● Historyofheadtrauma

● Historyoflossofconsciousness

● Presenceofdentalamalgams

● Historyofhypertension

● Consumptionofseedoils

● Neuroactivemedications(especiallywithanticholinergic

activity),directorindirect:e.g.,benzodiazepines,statins,

protonpumpinhibitors,antipsychotics,antihistamines,

anesthetics,ETOH,illicitdrugs,etc.

67y.o.womanwith2-yrhistoryof

progressivecognitivedecline

● Motherdiedwithdementia,onsetage62.

● Unabletonavigateonfreeway.

● Couldnotrememberwhatshehadread.

● Unabletopreparereportsforwork.

● Unabletorecalleven4-digitnumbers.

● Retinalscanpositiveforamyloid

● TreatedwithMEND(metabolicenhancementfor

neurodegeneration).

Case1D.D.● 44yofemale,counselor,c/oforgetfulness,unabletofind

wordsandforgettingclientsnames.“Feelsitis

progressing”

● Feelsshe’saddictedtosugar

● Parentsarevisiting:Motherhasaveryhealthylifestyle

andFatherisa“junkeater”;neitherhavememory

change

● Statesthatwhentheyarevisitingthisisabarriertoher

changingherlifestyle.

● Mostlysedentarywithoccasionalhike

Case1D.D.

● ApoEGenetestresults:¾

● Recommendeddietarychanges:initiallyavoiddairy

andredmeat.Eatgoodfatssuchasavocado,oliveoil;

basicallygaveherbabystepsduetoherresistance

● Dailyexercise:75%aerobic(sweatingisherfriend)

● Reviewedhistory:lowriskinfectionorheavymetal

toxicity.Probableleakygut

● Elevatedglucose(98);TSH3.35

● BeganNatureThroid;Berberinesupplement;initially

MCToilandincreaseingoodfats

Case1D.D.● InitiallyDDresistedchangefor6months

● Hadshifttobegincaringforherselfandbegandietary

changes;dailywalking;fasting3hoursbeforebedtime;

begantotal12hourfast

●Within8weeksLost17pounds;memoryissues

resolved

● ShechosenottoenrollinReCODEandwehavenot

completedtheevaluation

● Greatexampleofearlieryoutreatthebetter!

Theprotocolworksbestfor:● Presymptomatics(cf.7millionE4/4,75millionE4)

● SCI(subjectivecognitiveimpairment)

● MCI,especiallyifaMCIandidentifiablecontributors

● Peoplewithcognitivechangeswhoareotherwisehealthy.

● EarlyAD,especiallyifnotalreadyondonepezilor

memantine

● Theprotocolworksbestfor:•Non-type3SCI,MCI,orearly

AD

● Atrophylimitedtohippocampus

● Age<75

MentalHealthProfessional● ExtremelyimportanttofindMHPthatoffers

NeuroPsychtesting

● Communicationbetweenproviders

● Assistancewithevaluatingsafetyofclient

● Assistanceinevaluatinghistoryoftraumaandother

co-morbiddisease(i.e.depression)

● Supportforfamily

RiskFactors● PoorOralHygieneRootCanalsPeriodontalDs

● Sinusitis

● MetabolicSyndrome

● HistoryofETOHwithdrawalsymptoms

● Historyofvasculardisease

● Exposuretomitochondrialtoxins(i.e.antibiotics,

statins,ApoE4,griseofulvin,AZT,acetaminophen,

NSAIDS,cocaine,methamphetamine,L-DOPA,

● BMI>25

● Renal,hepatic,orpulmonarydisease?

RiskFactors● Sleep<7hours/night?

● SeropositiveforHSV-1?

● Headaches?

● Moldexposure?

● Historyofmeningitis?

● Historyofcancer?

● Glutensensitivityorotherfoodsensitivity?

PeopleYouSeeatRisk● Depression

● Anxiety

● Insomnia

● CardiovascularDisease(youmayseeafterMI)

● Menopause

● 48yofemalewithhistoryoftrauma,developssevere

anxietyandadmittedtolocalmentalhealthhospital.

MDidentifiedthatsheneededtoconsultregardsHRT

Case2● 52yearoldmale,married,retiredAirForce

●WorksfulltimeforAFbutrecentlyhisbosscounseled

himonjobperformancerelatedtomemoryissues

●Wifeextremelysupportive

● Lovestowoodworkingandbuildingthingsinhisshop

Case2

Case2

Case2

Nutrition● Nutritionisthemostimportantaspectoftreatment

● Avoidsimplecarbs,saturatedfatsandlowfiberdiet

● Hardlyanyonepresentswithagooddiet

● Plantbased

● Majorityofcaloriesfromnon-starchyvegetables(best

local,organic)andgoodfats.Includecookedandraw

vegetables,darkgreen,rainbow,andcrucifers

● Includedetoxifyingvegetablessuchascilantro,

cruciferousvegetables

Nutrition● Lowglycemicfruits

● Nofruitjuice

● Fish:wildcaught,SMASHfish(salmon,mackerel,

anchovies,sardines,herring).AvoidfishwithhighHg

(long-lived,largemouth)

● Meatiscondiment:wildgame;grassfedgrassfinished● Pasteurizedeggsandpoultry

● Avoidgluten,dairy,othersensitivities

● DirtydozenandCleanFifteenewg.org

Case3● 72yearoldmale,divorced,retiredDentistwithonsetof

memorydeclineat62

● Memorydeclinehasexceleratedoverpast2years

● Hehaslovingrelationshipbutrecentlyshemovedout

duetohissiblingsgettingmoreinvolvedindecisions

● Nolongercandrive,dailycaregiver

● Stays4nightsatgirlfriend’shouse

Case3

Case3

BredesenProtocolHealGut

Sleepisessentialtohealing

Assessforsleepapnea

Menopausal?

Meditation

Breathing–4-7-8

NeuralAgilityiAwaketechnologies;Centerpointe

Holosync

Caregivers● Anxiety

● Support

● Notcoveredinprotocol

Spiritual● Joy!

●WhatfeedsyourSoul?

● DowhatyouLove!

● Missingpieceoftreatment?

GODMeditation Forgiveness

Harmony

HealthPrayer

Good Food Happiness

Laughter

Jealousy

fear

Gossip

Negative Thoughts

Attitudes and EmotionsAddictionsSelf Pity

Anger

Hatred

FromListeningandCommunicatingwithEnergy–Dr.GingerBowler

Definitions● Spirituality:aninherentaspectofeveryhumanbeing

thatrelatestotheAbsolute–thatdomainwherevalues

andmeaningexist;theplacewhereHopeexists.

● Religion:abodyofbeliefsandpracticesdefinedbya

communityorsocietytowhichitsadherentsmutually

subscribe

SpiritualityinPractice● Takequiettimeforyourselftogowithin

● Reflectinnature

● Dothingsthatconnectyouwithsomethinglargerthan

yourself

● PracticeGratitude

SpiritualHistory● Importantpartofunderstandingculturalcontextof

patient

● Mayaffectwhyapatientmakesachoice

● Maynotbeappropriateforfirstvisitbutessentialfor

longtermpatientcenteredrelationship

● Variousapproachestoobtainingspiritualhistory

● Cognitivedeclineinvolvesallfamilyandfriendsin

treatment.Whatistheirsupport?Values?Beliefs?

Self-Care● SelfReflection

● Journaling

● Meditation

● Challengingyourframeofreference

EverydayLife

ModelBeliefs

WalkYourPath

MakeYourSELFaPriority BalanceYourPsychological/EmotionalEnergy

ChangeyourThoughtsaboutCircumstances

ChineseSymbolforCrisisisSameassymbolfor

opportunity

TurnObstaclesintoOpportunities

LearntoLookattheBigPICTURE

TheMindfulPractitioner● Mindfulnessenhancesrelationship-centeredcare

● “Atherapisthastopracticebeingfullypresentandhas

tocultivatetheenergyofcompassioninordertobe

helpful.”

● ThichNhatHanh

Summary● IntegrativeApproachtoChronicDisease

● APOEGene

● BredesenProtocolforAlzheimer’scare

● 3casediscussions

● CareoftheCaregiver

● CareofthePractitioner

Engineeringtheoutsideworld

cancreatecomfortand

convenience.Onlyengineering

theinteriorcancreate

wellbeing.

Sadhguru