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Integrative medicine updates

BY VICTOR S. SIERPINA, MD, ABFM, ABIHM, Director, Medical Student Education Program, WD and Laura Nell Nicholson Family Professor of Integrative Medicine, Professor, Family Medicine University of Texas Distinguished Teaching Professor

So many things have happened in the past year in the Integrative Medicine field that it is hard to keep up. I would remind you that there are a number of resources to keep you abreast of changes in Integrative Medicine, should you so choose. Also, there are numerous CME opportunities to discover the latest data on functional medicine, botanicals, lifestyle medicine, supplements, mind-body medicine, nutrition, and more.

For your reading pleasure, I direct you to the Weil Integrative Medicine Library of over a dozen titles on a variety of fields from integrative oncology, women’s and men’s health, pediatrics, psychiatry, gastroenterology, rheumatology, nursing, cardiology, and an upcoming one on pain management. I am working on a gastrointestinal disease chapter for a new title on Integrative Geriatrics, which will be out next year. These are well written, evidence-based, and referenced synopses of the state of the art in integrative medicine in a variety of areas from Oxford University Press. Surely one or more, and for many of you, all of them belong on your bookshelf and reading list.

For a newsy format, I enjoy Holistic Primary Care, a bimonthly newspaper format with the latest news and cutting edge developments in integrative medicine. I order a dozen copies to distribute to faculty, fellows, residents, and students. It is available for a low cost subscription or online at www.holisticprimarycare.net. They also offer an annual conference, Heal Your Practice, which is worth considering.

They are several peer reviewed journals including Explore: The Journal of Science and Healing, Alternative Therapies in Health and Medicine, Global Advances in Health and Medicine, Alternative and Complementary Therapies, Integrative Cancer Therapies, among others.

One of my favorite and most articulate blogs is by Dr. David Katz from Yale and current president of the Lifestyle Medicine Association. This comes out weekly and is free. To connect, go to www.davidkatzmd. com.

A monthly interview and synopsis of breaking scientific issues in integrative medicine is the audio journal Functional Medicine Update, published by Jeffrey Bland, PhD. He interviews thought leaders in a variety of fields, clinical, research, and education to elicit some of the evolving science in areas like pharmacogenomics, the microbiome, as they impact endocrinology, oncology, gastroenterology, neurology, and other clinical specialties. In the past year or so, he has put together a mini-series of 3-4 monthly topics to get really into depth in areas of critical health importance such as diabetes and dementia. To subscribe to this quality information source, go to www.jeffreybland.com.

As you can tell there are a wide variety of scientifically based literatures in this area. I prefer some more in depth book reading at times, and these are often written with the general public in mind, given the economics of publishing. Some recent examples are Missing Microbes by Martin Blaser. MD and The Gut Balance Revolution by Gerald Mullin MD, a functional gastroenterology specialist at Johns Hopkins.

In his book, Missing Microbes, NIH and New York University microbiome researcher Dr. Martin Blaser describes the link between multiple modern plagues and changes in the microbiome. Due to overuse of antibiotics, pesticides, increased cesarean section rates, and hygienic practices, children are not exposed to antigenic stimulation or provided a healthy gut biota profile. This results in autoimmune, inflammatory, and degenerative diseases so increasingly common in our society: cancer, diabetes, heart disease, obesity, Alzheimer’s, along with increased frequency of gastroesophageal reflux, Clostridium dificile, and antibiotic resistant superbugs. I recommend this for an informative read.

What about gluten? Much of the recent frenzy about gluten is likely just that. Most people claiming gluten intolerance likely do not have it. Substantial numbers without frank celiac deficiency, however, may have gluten sensitivity or intolerance. However, there are concerns about the impacts of celiac disease on central nervous system inflammation and white matter abnormalities on MRI and behavioral changes(1). In the same way that celiac disease affects the gut’s permeability, it also affects the blood-brain barrier. Symptoms as diverse as headaches, psychosis, and neurodegenerative changes have been linked to celiac disease, well beyond its known effects on gut, skin, and joints. A serum marker, Zonulin, is evolving as a biological marker which is elevated in those with clinically diagnosable celiac disease but also in those with non-celiac gluten sensitivity and to nearly the same levels(2). Expect to hear more about gluten sensitivity, the microbiome, and behavior in the future. Be tolerant of your patients who insist on trying to live gluten free. They may be right, or they may be crazy. A therapeutic trial is worthwhile in any case.

Finally, if you want to gain weight, drink diet sodas. According to research by Dr. Sharon Fowler at University of Texas Health Science Center in San Antonio, older adults who were overweight or obese gained significant waist circumference if they drank diet sodas(3). The non-nutritive artificial sweeteners are suspected from this and other studies to have altered the response of gut bacteria in metabolism to creating increased fatty acids.

Have a Healthy, Happy, and Prosperous New Year.

1.Currie S, et al. J Neurol Neurosurg Psych. 2012

2. Barbara, G. 23rd United European Gastroenterology Week, Barcelona, 2015

3. Fowler SP et al. Am J Geriatr Soc. 2015