Stephen Holt MD-Therapuetics With Natural Remedies_ FEB08

8/8/2019 Stephen Holt MD-Therapuetics With Natural Remedies_ FEB08

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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 of

natural products used in medicine

Ancient discipline of medicalscience

Pharmakon = drug, Gnosis =

knowledge


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CONCEPTS

Natural medicine cannot integrate intogeneral medical practice without ascientific base

Botanicals or herbs are drugs and

many drugs are botanicals or herbs, orsynthetic copies

Dietary supplement manufacturersexhibit widespread ignorance about

pharmaceutical science Hiding behind mythical and magical

thinking is no longer acceptable inintegrative medicine


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CONCEPTS

Some natural clinicians baulk at attemptsto 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 NUTRACEUTICAL

DISPOSITION 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 routeof delivery, chemical characteristics,processes of movement across

absorption barriers and physiologicalevents such as gastric emptying, ormodified by presence of disease, age etc

Some nutraceuticals claim that they have

absorption and bioavailability that cannotbe present, based on simple scientificprinciples


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ABSORPTION [examples]

FISH OIL: Unstable in regularformulations, denatured by gastric acid,power is with EPA. Dosage requirements

high, 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 have

dangerous pro-oxidant effects eg vit.C, E Most antioxidant supplements do not use

the correct principles of formulation


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METABOLISM

The process of chemical alteration ofdrugs 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 bythe 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 ofalternative 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 SUPPORTINGDATA

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 of

major importance Who formulated the supplements

you use in your practice?


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KEY PUBLIC HEALTH

INITIATIVES Lifestyle medicine combined withnutritional interventions have

overshadowed allopathic approaches

for many public health problems First line options for disease

prevention are not rooted generally in

drugs or surgery

Many factors have moved consumersof health care to the new paradigm of

simple, gentle and more natural

interventions


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KEY PUBLIC HEALTH

INITIATIVES

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 HEALTH

INITIATIVE 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 DiseaseCardiovascular 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 A

PROFIT 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 withsupplement purveyors


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ETHICS

Physicians must not engage in selfreferral

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 increasingly

indistinct

At least three quarters of all patients in an

out-patient, hospital, clinic are takingsupplements, some of which are worthless

A doctor who sells a dietary supplement

that is available in retail will ruin their

practice [A HUGE ISSUE] Supplement dispensation by healthcare

professionals will lead to the responsible

use of dietary supplements

Stephen Holt MD-Therapuetics With Natural Remedies_ FEB08

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