Deconstructing Modern Illness: Idiopathic or Iatrogenic?

Lucine Health Sciences, Inc. | Hormones Matter

Deconstructing Modern Illness

Idiopathic or Iatrogenic?

You did then what you knew how to do,

And when you knew better,

You did better. Maya Angelou

Core PrinciplesoPregnancy is an opportunity to break cycles of bad health oReproduction should be viewed from a much broader and longer

perspective. o Dad’s health matterso At least one year pre-conception – postpartum yearo Transgenerational – can’t undue sins of our parents and grandparents,

but we can protect our children and grandchildreno Everything is connected – a more holistic and systems approach

to health oHealth is complicated, disease is individual, we have a lot to learn

o If the symptoms don’t fit Dx categories, trust your gut and figure out what is wrong

IntroductionWho, what and why?

Who am I? oMom, wife, jock, researcher, writer, women’s health advocate

oBackground in maternal health and hormones

oMore recently, medication adverse reactions, nutrition and mitochondrial damage

What I Do Officially

What I Really Doo150,000+ monthly

o1200+ articles and growing

o150 guest contributors/writers

• 18 PhDs, 5 MDs, 2 DPTs

oThousands of comments

Cause trouble.

Listen and Learn

And Try to Untangle

The untanglible.

What I Have LearnedoEnvironment matters

• More than genetics

oHealth and disease are both sudden and slow

• Thresholds and tipping points

oAll about the mitochondria • Mitochondria determine everything

Everything we think we know is wrong.

Let the Deconstruction Begin.Do we know what we think we know?

“There is often something sinister about familiar concepts. The more familiar or ‘natural’ they appear, the less we

wonder what they mean; but because they are widespread and well-known, we tend to act as if we know what we

mean when we use them.” Devisch, I. & Murray, S., 2009. doi:10.1111/j.1365-2753.2009.01232.x

Just because it is familiar

Doesn’t make it right or true.

Framing the conversation

Implications of idiopathyoEverything we don’t understand is idiopathic

• Illness of unknown origin is random – we cannot know the causes

oWe have no responsibility for randomness• Choices/behaviors don’t matter

• No need to study

• Can only treat but never cure or prevent

Cancer is random?

“These results suggest that only a third of the variation in cancer risk among tissues is attributable to environmental factors or inherited predispositions. The majority is due to

‘bad luck,’ that is, random mutations arising during DNA replication in normal, noncancerous stem cells.”

Tomasetti & Vogelstein 2015. Science, Vol. 347, Issue 6217, pp. 78-81DOI: 10.1126/science.1260825

Randomness absolves us of responsibility

Randomness means we can ignore things like this

And this… o Pharmaceutical and

environmental chemicals rearrange MLL Gene via topoisomerase inhibition

• Glyphosate (and other herbicides/pesticides), fluoroquinolone antibiotics, hormonal contraceptives, HRT and other drugs

o Topoisomerases manage nDNA, mtDNA replication and repair.

MLL- related leukemias are not heritable, not found in germlines, but a result of exposure

in utero (infant leukemia) or during later child development (pediatric leukemia).

25-75% of the symptoms reported in outpatient settings are considered

medically unexplained.

How much of medicine is idiopathic?

Source: Smith, R.C. and Dwamena, F.C., 2007. Classification and diagnosis of patients with medically unexplained symptoms. Journal of general internal medicine, 22(5), pp.685-691.

Idiopathy exists, not because this stuff is unknowable, but rather, because we

choose not to look.

Source: Smith, R.C. and Dwamena, F.C., 2007. Classification and diagnosis of patients with medically unexplained symptoms. Journal of general internal medicine, 22(5), pp.685-691.

OF OB/GYN CLINCAL PRACTICE GUIDELINES

NOT BASED ON EVIDENCE

For women…

Idiopathy runs rampant.

OF MEDICAL INTERVENTIONS UNPROVEN

ONLY 35% KNOWN TO BE BENEFICIAL

Source: BMJ Clinical Evidence, http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html

For medicine in general

We really don’t know what we think we know.

Source: BMJ Clinical Evidence, http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html

Medication nationMayo Clinic Reportso70% adults take

prescription medications chronically

o50% take 2 or more meds

o20% take 5 or more meds

“Before the SSRIs, drugs were poisons that came with risks. Now they are fertilizers to be used as widely as possible, being given in ever larger amounts to children and the elderly - the only risks the authorities can see it would seem stem from not using enough of them.”

David Healy

If only 50% of medications have sufficient evidence of efficacy, what happens when we

combine multiple medications? Efficacy?Safety?

Can we really know what illnesses chronic polypharmacy use might spur if we’ve never

bothered to ask the question?

If 25-75% of symptoms can be considered medically unexplained, how certain are we of

our current diagnostics?

Maybe idiopathic is really iatrogenic?

The problem of iatrogenesiso3rd leading cause of death in hospitalized patients

• Estimated at 200,000-400,000 patients annually• 6.8% of cases were attributable to an adverse drug reaction 1964-

oFDA/ADR data (2011) • 2.1 to 2.7 million Americans suffer from an serious adverse drug

reaction annually • 128,000 result in death

James, J.T., 2013. A new, evidence-based estimate of patient harms associated with hospital care. Journal of patient safety, 9(3), pp.122-128; Null, G., Dean, C., Feldman, M. and Rasio, D., 2005. Death by medicine. Journal of Orthomolecular Medicine, 20(1), pp.21-34; Makary, M.A. and Daniel, M., 2016. Medical error—the third leading

cause of death in the US. Bmj, 353, p.i2139; Stokowski, L.A., 2016. Who believes that medical error is the third leading cause of hospital deaths. Medscape, May, 26Light, D.W., Lexchin, J. and Darrow, J.J., 2013. Institutional corruption of pharmaceuticals and the myth of safe and effective drugs; Light, D.W., Lexchin, J. and Darrow,

J.J., 2013. Institutional corruption of pharmaceuticals and the myth of safe and effective drugs..

Even as currently defined.

Implications of iatrogenesisoPresumes we know the scope of effects for a given

treatment• If 50% of treatments unproven, do we really know the scope

of effects? • Even when tested, often only tested in isolation, in men, with

little application to real world uses

oAnything we don’t know is random or idiopathic

oWe have no responsibility for randomness

oNo need to study

Deconstructing Women’s HealthWhere idiopathy, iatrogenesis and willful ignorance intersect.

Women use more medications than men

A review of insurance records for a 1 year period in 2010 showed: • Women = 5 prescriptions

• Men = 3.7 prescriptions

• 68% of women versus 59% of men had one prescription for at least one medication for a chronic or acute condition during the study period.

Women’s Health 2012: The 20th Annual Congress; https://www.washingtonpost.com/blogs/the-checkup/post/women-prescribed-more-drugs-than-men-but-dont-always-take-them-research-shows/2010/12/20/gIQAJm5hNS_blog.html?utm_term=.f913aa9f54a6

During Pregnancyo80% of women take at least

one medication during pregnancy

o~30% take 4 or more medications during pregnancy

• 60% increase in medication use during pregnancy in 30 years

Most of these drugs were never safety tested with womenoNo testing on drugs approved before 1993

oGuidelines not enacted until 1998

Even after the regulationsoPer the GAO (2000)

• 52% of clinical trial participants women, mostly later phases

• Only 22% of early phase trials, where safety and dosing determined

oPer the IOM OWH (2010)• Much the same

Here’s the thing

Even though women are now allowed in clinical trials, there is no requirement for researchers/drug companies to determine

whether women react differently than men to a medication before it is approved.

So they don’t.

As a resultoWomen suffer significantly more frequent and more

severe adverse drug events

oFew notice because none of these reactions were documented in the first place

Cardiovascular disease is the most common cause of death in American women and in recently recalled medications for heart

disease there were disproportionately higher fatalities and serious adverse events in women than in men.

– Cochrane Reports

Idiopathic or iatrogenic?

Ethical conundrumoTesting on women might impair reproductive

capacity

oMedication use during pregnancy might harm the fetus

oBUT women use medications across the lifespan and during pregnancy

• If we’re not going to test, should we really be recommending these medications to women?

Possible solutionsoAnimal testing

oUse meds only sparingly in pregnant women

oIntense post market surveillance

Might temper some of the risks

What do human females and male rodents have in common?

Apparently, they are equivalent.

Source: Beery, A., & Zucker, I. (2011). Sex Bias in Neuroscience and Biomedical Research. Neuroscience and Biobehavioral Reviews, 35 (3), 565-572.; https://genderedinnovations.stanford.edu/case-studies/animals.html

No one considered

Until 2014!

that males and females might be different

Perhaps it’s not about ethics at all, but rather, expediency.

Long, inglorious history • Used from 1957-1961 as

anti-emetic, hyperemesis mostly in Europe

• 2000-100,000 children born with severely malformed limbs

• FDA denied approval

Thalidomide -prescribed for morning sickness Of medicating women.

Diethylstilbestrol (DES) – to prevent miscarriage At least 3 generations affected: sons, daughters

and grandchildren

Without research• 5-10 million women from 1940-

1970s• FDA approved, no research• Late 50s-60s first research:

increased risk of miscarriage• Multi-generational damage

(cancer, organ malformation, more)

• Used in farm animals• Caused cancer in farm hands,

miscarriage and illness in animals

• Banned in 1958 in animals• Still used in women for another

20+ years

Or dubious research

For male satisfaction

And for social reasons

1959-1970s physicians and researchers from the Royal Children’s

Hospital and the University of Melbourne gave adolescent girls of

tall stature DES to stunt growth. The rationale behind treating tall girls

was so they could do ballet, buy clothes more easily, and find

boyfriends and husbands.

Source: Lee & Howell, Tall girls: the social shaping of a medical therapy. Arch Pediatr Adolesc Med. 2006 Oct;160(10):1035-9.

When Being a Tall Girl was a Medical Condition: DES and the Tall Girls

And then covering it up

Used as a pregnancy test 1960s-70s

Equivalent to 13 morning after pills or 157 oral contraceptive pills

January 1975, Dr William Inman, principal medical officer for the British Government, had found that women who took a hormone pregnancy test “had a five-to-one risk of giving birth to a child with malformations”.

Dr Inman wrote to Primodos’s German manufacturer, Schering, so the firm could “take measures to avoid medico-legal problems”, rather than recall the drug.

A later document explains that Dr Inman destroyed the materials on which his findings were based, “to prevent individual claims being based on his material”.

Source: http://www.telegraph.co.uk/news/2017/03/18/new-evidence-claims-against-pregnancy-test-drugs-linked-birth/

It’s worse for pregnant women

• There are no data for [insert vaccine] administered to pregnant women to inform vaccine-associated Package insert

• Available data on [insert vaccine] administered to pregnant women are insufficient to inform vaccine-associated risks in pregnancy.

• There were no developmental toxicity studies of [insert vaccine] performed in animals.

• It is not known whether [insert vaccine] is excreted in human milk.

• Data are not available to assess the effects of on the breastfed infant or on milk production/excretion.

Despite all marketing to the contrary, most

medications and vaccines were never tested for use during

pregnancy.

Source: Package inserts

We never learned

With little evidence of safety and efficacy

We continue to drug women

And for childrenoOnly 10-20% of

medications for pediatric use have been tested in children

oPharmacokinetic and pharmacodynamic research developed in adult males

oRampant off-label for kids, particularly kids in foster care

Sources: Conroy, S., McIntyre, J., Choonara, I., & Stephenson, T. (2000). Drug trials in children: problems and the way forward. British Journal of Clinical Pharmacology, 49(2), 93–97. http://doi.org/10.1046/j.1365-2125.2000.00125.x ; FDA, https://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm143565.htm;

http://pharmaceuticalcommerce.com/brand-marketing-communications/pediatric-drug-market-finds-its-own-pathway/

“In the absence of rigorous pediatric clinical trial data, physicians are forced to act as if

children are just ‘small adults’ with a smaller weight, and then interpret the adult data to

adjust the dose. But statistically, we know that approach only works in 6% of the cases.”

We’re addictedPsychotropics prescribed in the US o 274,000 infants (0-1 year

olds)o 370,000 toddlers (1-3 year

olds)“Prescriptions of powerful antipsychotics such as Risperdal for

infants and very young children have also sharply risen. Office visits for

childhood bipolar disorder have risen 40-fold over the past decade in the

U.S.” To solving problems with pills and looking away when problems arise.

If drugs are not tested in women or children and thus, their effects in women are unknown, they can easily be disregarded

and labeled as idiopathic. If they are idiopathic, rather than iatrogenic, there is no need

to investigate or even acknowledge side effects as real. For all intents and purposes, they simply do not exist.

For example o Lupron – GnRHa

• Chemically castrates

oDeveloped for male prostate cancer

• Tested on 6 healthy men

• One low dose for a drug to be used repeatedly and chronically at higher doses

oApproved for

• Women with endometriosis, fibroids, heavy bleeding

• IVF

• Children with precocious puberty, gender dysphoria

Considered perfectly safe by many practitioners

• No recognition chemical castration might cause problems

• Depletes gonadal hormones

• Hormones have receptors everywhere and are involved with a myriad of functions beyond reproduction

• With very little research pre – or post-market, symptoms are considered idiopathic or hysteric.

It’s not safe

Lupron damages the mitochondria, perhaps irrevocably.

How bad is it?

Really bad.

Because we don’t recognize the possibility of ill-effects

They effectively do not exist.

We are drowning

in a sea of toxins

Environmental toxic soup“Unlike the current system in Europe, the 60,000-plus chemicals in production when the US’s TSCA took effect 39 years ago continued to be used without any safety reviews. Most are still in use today, although some have since filed toxicity data.The US allows the use of many chemicals that are banned elsewhere, and its primary chemicals law has failed to keep up with thousands of chemicals currently in use, including the approximately 2,000 new chemicals introduced each year.”

Source: https://www.theguardian.com/lifeandstyle/2015/feb/13/us-senate-toxic-chemicals-law-health-safety

Friday 13 February 2015 13.41 EST

That remain in our bodies

Certain polychlorinated biphenyls, organochlorine pesticides, PFCs, phenols, PBDEs, phthalates, polycyclic aromatic hydrocarbons, and perchlorate were detected in 99–100% of pregnant women. The median number of detected chemicals by chemical class ranged from 4 of 12 PFCs to 9 of 13 phthalates. Across chemical classes, median number ranged from 8 of 17 chemical analytes to 50 of 71 chemical analytes.

BPA and tOP were detected in 92.6% and 57.4% of the persons, respectively...Females had statistically higher BPA LSGM concentrations than males (p = 0.043). Children had higher concentrations than adolescents (p < 0.001), who in turn had higher concentrations than adults (p = 0.003).

Affecting generations to come

What would normally filter the damage

Medicines Toxins Bad diet

Nutrients Exercise

Has been compromised.

Maternal nutrient deficiency is rampant

Oxidative stress caused by free radicals has been implicated in many studies of the etiology of preeclampsia (38). Because ascorbic acid and vitamin E inhibit free radical formation, a double-blind randomized trial was conducted in 283 women who had either a previous history of pregnancy complications or an abnormal ultrasound (39). The supplement provided 1000 mg ascorbic acid and 400 IU vitamin E daily from week 16–22 of pregnancy, and resulted in a 76% reduction in preeclampsia, and a 21% reduction in indicators of endothelial activation and placental dysfunction.

Evidence from experimental animals supports the concept that in addition to primary deficiencies, secondary embryonic and fetal nutritional deficiencies can be caused by diverse factors including genetics, maternal disease, toxicant insults and physiological stressors that can trigger a maternal acute phase response. These secondary responses may be significant contributors to the occurrence of birth defects. An implication of the above is that the frequency and severity of pregnancy complications may be reduced through an improvement in the micronutrient status of the mother .

Micronutrient status in fetal and early life may alter metabolism, vasculature, and organ growth and function, leading to increased risk of cardiometabolic disorders, adiposity, altered kidney function, and, ultimately, to type 2 diabetes and cardiovascular diseases.

The food we eat

Isn’t really food

High calorie malnutrition

It’s food like

We’re told it’s real food“Everything nature can do, man can do so much better and more profitably.”

o ‘Natural’ cheese that matures in 72 hours.

o Preservatives prevent produce browning

And if we can’t, then re-defineo ‘Clean labeling’ removes the most

glaring industrial ingredients and replaces them with substitutes that sound natural and benign.

“For the salesman, this preparation was a technical triumph, a boon to caterers who would otherwise waste unsold food. There was a further benefit: NatureSeal is classed as a processing aid, not an ingredient, so there’s no need to declare it on the label, no obligation to tell consumers that their “fresh” fruit salad is weeks old.”

But it isn’t.

Industrial food productiono Highly processed food-like products

o Sugar, carbs, fats and chemicals

o Genetically culled produceo 70% reduced nutrient contento With no genetic variation ( 96%)

o Glyphosate, toxic adjuvants and more

o Chemically laden meats o Heavy antibiotics, antibiotic resistant

bacteria, growth and other hormonesHas stripped our food of critical nutrients

It’s an industrial descaling agent

oUsed to remove minerals from pipesoDoes the same in our bodies

• Blocks critical enzymes and amino acids

• Disrupts vitamin A metabolism

• Weakens the blood brain barrier

oCarcinogenic, mutagenic, teratogenic and an endocrine disruptor

• Topoisomerase inhibitor

• Glycine analog

• Mineral chelator

oWould kill all the plants if not genetically altered to withstand the toxinAnd a powerful antibiotic.

A perfect storm

Of pharmaceutical and environmental toxicants.

But, cancer is random?

And most women’s symptoms are psychosomatic – until they aren’t’.

ConsequencesThe rise of random ill-health.

Suffering from a multitude of chronic illnesses

With generational effects

Increase in childhood illnesso1-68 children develop

autism o Neurodevelopmental and behavioral

problems on the rise

o1 in 13 children food allergies

o1 in 1000 – 10,000 children with autoimmune disorder (celiac, JA, TD1)JAMA Pediatr. 2013;167(2):141-148; Psychiatry (Edgmont). Aug 2005; 2(8): 14–19; Arch Gen Psychiatry. 2012;69(12):1247-1256; BMC

Pediatrics 2013, 13:40 3; JAMA. 2014;311(17):1778-1786.

Idiopathic or random?

Something is not working• Spend more healthcare• Highly vaccinated • Taking lots of meds

• That were never tested on over half the population

• Of those, only 50% considered effective

• Embrace environmental/industrial chemistry

• Living sicker• With increasingly

complicated but ‘random’ diseases

• Dying younger

How can we reasonably assert

Which health issues are idiopathic and which are caused by us?

Except in rare casesoMost modern illness is iatrogenic – caused by us

• Our choices individually and collectively• Diet, lifestyle, pharmaceutical and environmental decisions

“I believe the collective denial of lifestyle disease is the reason cardiology is in an innovation rut. This denial is not active or overt. It is indolent and

apathetic… This is how I see modern cardiology. Our tricks can no longer overcome eating too much and moving too little. We approach health but

never get there. If you waddle, snore at night, and cannot see your toes while standing, how much will a statin or ACE inhibitor or even LCZ696 help?”

Mandrola, J., 2015. Heart Disease and Lifestyle: Why Are Doctors in Denial? Medscape. http://www.medscape.com/viewarticle/837975

A hard truth that none of us wants to admit

Now what? Who cares whether we call it idiopathic or iatrogenic, how do we fix this mess?

Easy answeroStop

• eating food-like products• looking for medical

solutions to what are lifestyle issues

oGo back to basics• What does your body

need and is it getting it?

More complicated answeroFind the root causes of illness and

fix them• Stop treating symptoms

• Learn the chemistry

oBecome an expert in your/your family’s health

• Own your health

oShare what you learn with others • Build the knowledge base

• Publish/post online if you canEntire model has to change.

What I have learned

It’s all about the mitochondria.

Feed them well and life will be good.

Mitochondriao1000-2000 per cell

oFuel source for cells • Convert food to ATP

oSit at center of cell survival• Sense and respond to all threats

oMasters at adapting to toxic environments – until they aren’t

• Seemingly endless repertoire of survival cascades• Threshold and tipping points

But that’s not all they do oMitochondria control just about everything

o Energy

o Steroidogenesis

o Inflammatory and immune activation/deactivation

o Ca2+ homeostasis (cell excitotoxicity)

o Apoptosis/necrosisDamage at your own risk.

All they ask of us is to feed them welloTo get from food to

ATP• O2 (mitochondria

need to breathe)• Lots of nutrients

• >24 vitamins and minerals

And not hurl too many poisons at them.Source: https://www.invitehealth.com/ARTICLE-nutrition-and-fibromyalgia.html

Western diet = high calorie malnutrition.

We don’t.

Nutrient deficiency alone will damage mitochondria, evoke chronic and complicated illness and can lead to

death.

All pharmaceutical, environmental, and industrial chemicals damage the

mitochondria and deplete nutrients.

But wait, there’s more…

Mitochondria are targets

Sensors of cell danger

Poor nutrition, high toxic load

Foundation from which most parents-to-be approach reproduction

With the cascade of ill-health already in

progress.

Net result“These are partial defects.

Mitochondrial dysfunction doesn’t really cause anything, what it does is

predisposes towards seemingly everything. It’s one of many risk factors

in multifactorial disease. It can predispose towards epilepsy, chronic

fatigue, and even autism, but it doesn’t do it alone. It does it in combination with other factors, which is why in a family with a single mutation going through the family, everyone in the family is affected in a different way. Because it predisposes for disease

throughout the entire system.” Dr. Richard Boles, Geneticist

Complicated disease processes that affect everything and don’t fit our neat little

diagnostic categories.

How prevalent is mitochondrial disease or dysfunction?

“Disorders of the mitochondrial respiratory chain affect at least 1 in 8000 of the population, making them among the most common genetically determined diseases.”

Patrick Chinnery, Medical School, Newcastle upon Tyne.

Prevalence is likely underestimated because functional mitochondrial damage is often overlooked and most mitochondrial deficits, especially those emerging later in life, remain undiagnosed.

Not widely recognized

1 in 500

Energy is key• Insufficient mitochondrial ATP

• Cells adapt alternative, less efficient energy pathwayso Cancer pathways or they die

• Mitochondria activate danger protocols and deactivate extraneous tasks

• Cells die, tissues die, organs die, and we die (sometimes slowly and painfully, sometimes quickly)

How important are nutrientsoCells cannot ‘breathe’ without certain

vitamins and minerals• Thiamine and magnesium

oNutrient deficiency causes cellular hypoxia • No obstruction necessary

oBrain and heart most adversely effected

During pregnancy

Direct Mitochondrial membrane

permeability changes Alter channel open times Activate death pathways

Indirect Block critical nutrient co-factors

for ATP Alters hormone activity

(endocrine disruptors) Activate/deactivate critical

transcription and repair proteins (epigenetics)

Cycle of damage

mtDNA damage

Functional deficits

mtDNA mutation

Altered ETCDecreased

ATPMito damage

Increased ROS

Oxidative stress

Toxic ExposuresMedications, Vaccines, Environmental

Cell death & disease

Cascade of ill health

Not just about momo mDNA passed from mom-child,

o But mitochondria rely on nuclear DNA to function (~90%)

o If Dad is unhealthy and nutrient deficient, dysfunctional mitochondria are possible in the offspring, even if mom is healthy

Dad’s health matters too!

Long before conceptionoThe lifetime of unhealthy habits affect your

mitochondria o Mitochondria have memories

oCleaning up a few months before conception is good but not good enougho Should consider health of both parents at least a

year before conception

Health has to be considered

Nutrients minimize damage

Medicines Toxins Diet

Nutrients Exercise

Nutrient deficiency maximizes damage.

All comes back to nutrients

Avoid the toxinsClean up the dietFeed the deficiencies

Idiopathy versus iatrogenesisoWhen presented with complicated case, a disease process

that doesn’t seem to fit into any one category• Remove the notion of randomness/idiopathy • Return the notion of responsibility• Figure it out (together)• Think mitochondria

oAsk • What the patient needs to be healthy• Are they getting it

oFix it

Websites

o LucineHealthSciences.com I Business

o HormonesMatter.com I online journal, medication adverse events surveys

Social Media o Facebook pages: Hormones Matter, Lucine Women Community

o Twitter: @chanatlucine, @hormonesmatter

o Email: chandler@lucinehealthsciences.com or chandler@hormonesmatter.com

How to find me

Deconstructing Modern Illness: Idiopathic or Iatrogenic?

Health & Medicine

Transcript of Deconstructing Modern Illness: Idiopathic or Iatrogenic?

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