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An Introduction to Integrative and Functional Medicine ? Vulvar Disorders ?

An Introduction to Integrative and Functional Medicine ? Vulvar Disorders ?. Rebecca A. Malamed M.D. I ntegrative and Functional Medicine Pain Management. What is Integrative and Functional M edicine?. Integrative medicine Healing- oriented medicine Focus on therapeutic relationship

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An Introduction to Integrative and Functional Medicine ? Vulvar Disorders ?

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  1. An Introduction to Integrative and Functional Medicine? Vulvar Disorders ? Rebecca A. Malamed M.D. Integrative and Functional Medicine Pain Management

  2. What is Integrative and Functional Medicine? • Integrative medicine • Healing- oriented medicine • Focus on therapeutic relationship • Whole person (body, mind, and spirit) • All appropriate therapies, both conventional and alternative • Functional medicine • Dysfunctions of physiology and biochemistry • Chronic disease assessment, prevention and Rx

  3. Differences in Diagnostic Approaches • Conventional Medicine: • Disease/disorder based diagnosis • Vulvovaginitis, Vulvodynia, Lichens Scleroris, Lichen Planus, Hyperplasia, Neoplasia • Search for “magic bullet” as Rx • Integrative/Functional Medicine: • All symptoms in ANY system relevant • “Anything can cause anything” • Search for underlying function to Rx • Functional Medicine testing

  4. Differences in Treatment Approach • Conventional medicine • “Evidence-based” • Gold Standard: double-blind placebo-controlled • Pharmaceutical/intervention driven Rx • Integrative/Functional medicine • Basic research-based • Gold Standard: Individual patient symptom resolution • Least harmful/synergistic Rx to allow body to heal

  5. Your Genes on Twinkies • Environment and Gene Expression account for almost all human disease (Epigenetics) • Disease vs. Health is an expression of each patients: • Genetic predisposition: Cofactors, Detoxification, Immunity • Physical Environment: Nutrition, toxins (heavy metals, fungus, sucrose/fructose), sleep, exercise • Emotional milieu: Family, friends, mental health • Spiritual beliefs and practices

  6. The 7 Organizing Systems Where Clinical Imbalances Develop • Assimilation: Digestion,absorption, microbiota/gi, respiration • Defense and Repair: Immune,inflammation,infection/microbiota • Energy: Energy regulation, mitochondrial function • Biotransformation and Elimination: Toxicity,detoxification • Transport: Cardiovascular, lymphatic system • Communication: Endocrine, neurotransmitters, immune messengers • Structural Integrity: From subcellular membranes to musculoskeletal structure

  7. Assimilation • Complete and healthy absorption requires • Intact intestinal villi • Food Sensitivities can damage and destroy intestinal villi • Mediated through IgA Immediate Type Hypersensitivity Reactions

  8. Destruction of Intestinal Villi in Celiac Disease

  9. Assimilation • Absorption • Increased intestinal permeability can lead to symptoms or signs of ANY inflammatory condition locally or systemically • Mediated through IgG delayed type hypersensitivity

  10. Leaky Gut Progression INTACT PROTEINS

  11. Assimilation • Microbiome: 100 trillion bacteria • Skin, gut, mouth, vagina • Local antimicrobial treatment not sufficient? • Healthy microbiome (balanced flora) • Dysbiosis (opportunistic species predominate) • Vulvar-vaginosis, vulvodynia and other vulvar disorders may have abnormal GI flora as precursor

  12. Defense and Repair • Decreased Immunity • Host defense vs. virulence of organism • Vulvar-vaginosis, Vulvodynia • Excessive Immunity = Inflammation • Food sensitivities (IgG, IgA), Toxins • Autoimmunity • Vulvodynia, Lichens Scleroris, Lichen Planus, Hyperplasia, Neoplasia

  13. Biotransformation and Elimination • We are what we eat? Actually… • Want cleanest in and dirtiest out • Limit toxicity and need for detoxification • Vulvovaginal disorders may be caused by an accumulation of inflammatory mediators locally and total body burden of toxins

  14. Toxicity • Natural: Plants and microbes • Manmade: Chemical, heavy metals etc. • 60,000 to 80,000 in common use • $1.5 trillion in 2010 sales by Census Bureau • Backlog of 10,000 never tested by EPA • US largest manufacturing sector

  15. The Liver Detox Pathways and Essential Nutrients

  16. Diet recommendations • Organic/Biodynamic • Non-GMO • Corn, soybeans, canola, papaya, sugar beets • Avoid processed food • Pesticides, dyes, additives • Candida diet • Low glycemic, non-fermented (no alcohol, soy sauce) • Cook and store food with stainless/glass

  17. Elimination Diet for Food Sensitivities • Most Common • Eggs, dairy, gluten, corn, soy • Nightshades (Solanine) • Potatoes, eggplant, peppers , tomatoes • Methylxanthines • Chocolate, coffee, caffeinated tea • Any food cravings

  18. Rx Toxins/Irritants • Chlorine • Filtered water (drinking/bathing) • Organic cotton underwear • Hygiene products • Organic tampons, non-toxic soaps etc. • Environmental working group (EWG) • Heavy metals • Mercury: amalgams, predatory fish • Lead: solder in water pipes, paint, leaded gasoline • Aluminum: cookware, antiperspirant • Mineral Cosmetics, Gadolinium contrast dye

  19. Natural Detoxification • Sweating • Hot baths, saunas (infrared), exercise • Diet • STOP SUGAR • Dark leafy greens, garlic, onions, cruciferous vegetables, seaweed • Deep Breathing • Exercise, meditation • Fiber • Organic oat bran, charcoal, bentonite clay • Supplements • Glutathione, vitamin E, glycine, taurine, NAC etc.

  20. Goals of Natural Antimicrobials, Immune Modulators and Detoxification • Increase innate host resistance and immunity • Downregulation of excessive inflammation • Balancing of microbiome synergistically • Prevention of microbial resistance

  21. Natural Antimicrobials • Prebiotics/Probiotics • Inulin, fermented vegetables • Multiple probiotic strains • Coconut oil • (MCFA, Lauric acid, Caprylic acid) • Essential oils • Tea Tree, Lavender, Oregano • Herbs/Barks/Mushrooms • Pau D’Arco, Berberine, Sweet Wormwood, Reishi

  22. Natural Anti-inflammatories • Omega-3 & Omega-6 Essential Fatty Acids • Grass fed beef/lamb/dairy (omega-3) • Organic nuts and seeds (omega-6) • Fish oil (omega-3) • Blackcurrant seed oil (GLA,) • Sesame seed oil (omega-6) • Antioxidants • Dark green leafy vegetables, cruciferous vegetables • Turmeric (curcumin), Red grapes (Resveratrol)

  23. Summary • Our genes + our environment = our health • “Anything can cause anything” • Goals: • Increase host immunity and defense • Decrease (modulate) inflammation appropriately • Method: • Removing environmental stressors • Optimizing underlying biochemistry • Offer synergistic support of body systems

  24. More Information • Related articles @ www.drrebecca.com • Dysbiosis- a gut reaction • Food sensitivities and allergies • Sugar - not so sweet after all • Heavy metals • Detoxification - an essential process • Acute and chronic inflammation - more than just a pain • A balanced diet - why’s it so complicated? • Genetically modified food - what’s for dinner? • Probiotics in prebiotic • Dietary fiber - the lost nutrient Rebecca A. Malamed MD 10780 Santa Monica Blvd. #480, Los Angeles CA 90025 310-474-8111 / dr@drrebecca.com

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