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Parasitic Microbial Influences in Chronic Complex IllnessThe Scientific Basis Jeff Wulfman, MD Family Physician, Bristol, VT, Assistant Clinical Professor Family Medicine Univ. of VT Academy of Comprehensive Integrative Medicine (ACIM) Conference: Integrative Lyme Solutions, June 21-22, Ft. Worth, TX Evidenced-based medicine, heterogeneity of treatment effects, and the trouble with averages. Kravitz RL, et al Milbank Q 2004 • “The individual patient is not a numeric average but, rather, falls somewhere on the continuum of the bell curve and, hence, requires individualized care. Clinical guidelines should not supplant the judgment of treating physicians. Quality patient care requires the physician to consider management decisions in light of the details unique to each patient.” We are not sterile, we are a “superorganism”, colonies of creatures. • The Human Microbiome: • The microbiome is the full collection of microbes (bacteria, fungi, viruses, etc) that naturally exist within the human body ... Our adult bodies harbor 10 times more microbial cells than human cells. (and 100x’s more genes) Their genomes (the microbiome) endows us with physiological capacities that we have not had to evolve on our own and thus are both a manifestation of who we are genetically and metabolically and a reflection of our state of well being. (NIH) • Our human body is an amalgam of human cells and microbial cells, all must function in a healthy synergistic way for our maximum health to be achieved. This is an expansion in concept of who we are and what we are made of. This recognition of the importance of the microbiome has led the NIH to the establishment of the Human Microbiome Project with the goal of typing 100 organisms that are normal commensals of a health human gut. Again, it will be an open process, cooperation- in-discovery, involving scientists from all over the world. Symbioses • “Symbioses, prolonged associations between organisms often widely separated phylogenetically, are more common in biology than we once thought and have been neglected as a phenomenon worthy of study on its own merits. Extending along a dynamic continuum from antagonistic to cooperative and often involving elements of both antagonism and mutualism, symbioses involve pathogens, commensals, and mutualists interacting in myriad ways over the evolutionary history of the involved “partners.”…Symbioses can be: – mutualistic (all partners benefiting), – commensalistic (one benefiting and the others unharmed) – parasitic (one benefiting and other harmed) although many symbiotic associations are complex or poorly understood and do not fit neatly into one category. – Evolving Together: the biology of symbiosis, Gregory Dimijian, MD, Proc (Bayl Univ Med Cent). 2000 July; 13(3): 217–226. PMCID: PMC1317043 Host-microbe: symbiotic dynamics: Mutualistic Commensalistic Parasitic “Emerging Infectious Determinants of Chronic Diseases” • CDC-Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 12, No. 7, July 2006 Siobhán M. O’Connor,* Christopher E. Taylor,† and James M. Hughes‡ • “…noncommunicable chronic diseases can stem from infectious agents. Furthermore, at least 13 of 39 recently described infectious agents (incl. Borrelia) induce chronic syndromes …creating opportunities to reduce the impact of chronic disease by preventing or treating infection.” Parasite Paradigm • “parasite”- from ancient Greek “parasitos” meaning “beside food”, initially social description- mooching officials serving at temple feasts – much later applied to biology: – Parasitism is a type of symbiotic relationship between two different organisms where one organism, the parasite, takes favor from the host, sometimes for a prolonged time. In general, parasites are much smaller than their hosts, show a high degree of specialization for their mode of life, and reproduce more quickly and in greater numbers than their hosts. The harm and benefit in parasitic interactions concern the biological fitness of the organisms involved. Parasites reduce host fitness in many ways, ranging from general or specialized pathology . Parasites increase their fitness by exploiting hosts for food, habitat and dispersal. …it is best considered part of a continuum of types of interactions between species, -”parasite”- broad definition- persistent infection- bacterial, fungal, viral, protozoal, etc… “Parasites” • Micro-parasites: – – – – – protozoa Yeast/fungi Bacteria Viruses prions • Macro-parasites: – – – – Worms- large and microfilaria Mites Larvae Etc…?? “Parasites”/chronic infection: survival specialists • Complex effects-interactions, variable – Genetic manipulation- new genes/incorporation into host, mutations, differential expression of existing genes – Affect the other organisms already there, and vice-versa , Quorum-sensing, species interaction, gene exchange – Defensive strategies: Biofilm formation, dormancy, intracellular, cloaking, molecular mimicry (“autoimmunity”), Polymorphism- multiple forms (cyst/round-bodies, cell-wall deficient, granules, etc…) A Theory of Chronic Illness (?and acute illness)- IMMUNE SYSTEM MICROBES HOST A Chronic Illness Paradigm Immune system stressors hormones Emotions/spirituality Immune system Gut abnormalities Nutrients: MicrobesBacteria Yeast Virus Protozoa Worms Etc… Host “genetic Susceptibilities” -deficiencies -excesses Etc…! Metals Toxins, Mold Foundational Principles in the chronically ill • 1. Total Microbial Burden: Chronic Parasitism • 2. Immune Dysfunction: Inflammation – Increased activity “Inflammation” – Reduced effectiveness a relative “immune deficiency”, Incomplete clearance of microbes, etc… “INFECTION”-chronic parasitism “my body is on fire” DIRECT TOXIC EFFECTS and INFLAMMATION Hyperinflammatory but poorly effective: cytokine smog Downstream dysfunctions: evolve over time HPA axis and hormonal disruption, altered detoxification, Autoimmunity, multi-organ dysfunction, altered/compromised immunity, behavioral changes, altered biologic terrain Increased Total Microbial Burden: -Acquire new infections -Emerge out of dormancy -Shift from commensal to parasitic Microbes and… – Alzheimers: 90% spirochetes, 80% chlamydophila, HSV… – Autism: 16X more likely –Borrelia, fungi, viruses, mycoplasma, etc… – Multiple Sclerosis: 90+% Chlamydophila/mycoplasma/Borrelia – Chronic Fatigue Syndrome: 18X more likely: mycoplasma, borrelia, hhv-6, cmv, etc… – Atherosclerosis/MI/stroke: increased w increase total microbial load – Premature labor: linear relationship btw. Total load of microbes in amniotic fluid (>18species) – Etc……! G Nicolson, others Alzheimer's disease - a neurospirochetosis. Analysis of the evidence following Koch's and Hill's criteria. Journal of Neuroinflammation 2011, 8:90doi:10.1186/1742-2094-8-90 Judith Miklossy BLOOD: A MICROBIAL ECOSYSTEM “Although counter intuitive, it is increasingly obvious that microorganisms, including Anaplasma, Babesia, Bartonella, Borrelia, Chlamydia, Ehrlichia, Leishmania, Mycoplasma species and retroviruses can persist in the blood or other tissues of animals for protracted periods of time (months to years).” PERSISTENT BLOOD-BORNE INFECTIONS AND COMPLEX DISEASE EXPRESSION Edward B. Breitschwerdt, DVM, DACVIM Chief Scientific Officer, Galaxy Diagnostics, Inc. Professor, Internal Medicine, NCSU, Raleigh, NC Adjunct Professor of Medicine, Duke University Medical Center http://www.galaxydx.com/web/wpcontent/uploads/2010/05/PersistentBloodBorneInfections.pdf HHV-6 Reactivation • 65% of pt’s admitted to ICU (medical/surgical/trauma) are DNA+ for HHV-6 (active infection) • 0% in healthy volunteers (silent carriers) • Reactivation of human b-herpesviruses (cytomegalovirus [CMV], human herpesvirus [HHV]–6, and HHV-7) in nonimmunocompromised hosts is rare. viruses are susceptible to reactivation by cytokines and stress-related mechanisms, the incidence of their reactivation was investigated among 120 patients during stress Because these related to critical illness and compared with findings among 50 healthy volunteers. Human b-herpesvirus DNA was found in 65% of critically ill patients (60% men; mean age, 63 years) who required admission to an intensive care unit for medical (40%) or surgical (53%) indications or trauma (7%). HHV-6 reactivation was higher in critically ill patients than in healthy volunteers (54/101 vs. 0/50; P 1⁄4 .001). All patients except 1 were confirmed as HHV-6 variant A (mean virus load, 5066 copies/106 peripheral blood leukocytes). The reactivation of HHV-6A did not affect disease severity and outcome. No significant reactivation of HHV-7 or CMV was demonstrated among the critically ill patients. These findings contribute to the less-defined epidemiology of HHV-6A infection. – Selective Reactivation of Human Herpesvirus 6 Variant A Occurs in Critically Ill Immunocompetent Hosts, Raymund R. Razonable, et al; The Journal of Infectious Diseases2002;185:110–3 Multiple Microbial Effects: • Gene alteration: Borreliaupregulates >300 genes in macrophage, Anaplasma epigenetic silencing of multiple host cell defense genes • Inhibit Mitochondrial Metabolism (eg-Ehrlichia) • Vascular Changes: e.g.- altered cerebral blood flow and metabolism • Gautam A, et al, Infect Immun 2011 09 26; Jose C. Garcia-Garcia, PLoS Pathog 5(6): e1000488; Microbes Infect. 2011 Mar;13(3):232-8. Epub 2010 Nov 9., Liu Y, et al; Arch Gen Psychiatry. 2009 May;66(5):554-63. Lyme Disease (Borrelia burgdorferi) 2011 Case Definition CSTE Position Statement Number: 10-ID-06, www.cdc.gov/osels/ph_surveillance/nndss/casedef/lyme_disease_Current.htm From the CDC: "This surveillance case definition was developed for national reporting of Lyme disease; it is not intended to be used in clinical diagnosis." • • From the FDA: – “The tests should be used only to support a clinical diagnosis of Lyme disease and should never be the primary basis for making diagnostic or treatment decisions.” (FDA Medical Bulletin) Role of serology in the diagnosis of Lyme disease. JAMA, 282(1): 62-65; 1999 Brown SL Hansen SL; Langone JJ. Ratio of actual:reported- ~10:1 per CDC, ~40:1 per Martha’s Vineyard (25 vs. 1000 rx’s) Definitions: • Lyme Borreliosis = Lyme Disease – Early Localized - skin only, no systemic symptoms – Early Disseminated - early stages with systemic symptoms (fatigue, myalgias, arthralgias, headache, multiple skin lesions, fever, etc, etc….) – Late Stage – prolonged evolving systemic symptoms – Neuroborreliosis- neurologic involvement Borrelia bacteria have been found in: • • • • • • • • • • • Bladder Blood Bone Brain CSF Eye Heart- endo/myo/peri Kidney Ligaments Liver Lung • • • • • • • • • Lymph nodes Muscle Nerves Skin Spinal cord Spleen Synovial fluid Synovial membranes Intracellular: endothelium, neurones, microglia, fibroblasts… • Biofilm: endocarditis, … Local and generalized hyper-inflammatory response with Elevated inflammatory cytokines (Tnf-a,,etc) in plasma, CSF, tissues, brain LYME/Borrelia Labs • Indirect tests: body’s response tosuggesting past exposure, not the organism itself, there can be false negatives and false positives. Tier 1 Tier 2 • ELISA (“lyme Ab or titer”)neg,equiv,pos • Western blot- IgG, IgM - “positive or negative” based off of number of bands present (corresponding to Ag’s) During the Acute Phase (<3mos)of Lyme Disease: • A single sample 2-tier testing scheme will be NEGATIVE in >50% of patients (EM+) – Sex Differences in the Clinical and Serologic Presentation of Early Lyme Disease: Results From a Retrospective Review : Alison Schwarzwalder, MPH, et al; Gender Medicine/Vol. 7, no. 4, 2010 – Aguero-Rosenfeld, ME, Nowakowski, J, McKenna, DF, Carbonaro, CA, and GP Wormser. "Evolution of the serologic response to Borrelia burgdorferi in treated patients with culture-confirmed erythema migrans." Journal of Clinical Microbiology 34 (1996): 1-9 – Nowakowski, J.,et al, 2001. Laboratory diagnostic techniques for patients with early Lyme disease associated with erythema migrans: a comparison of different tech- niques. Clin. Infect. Dis. 33:2023–2027. • Two-tier serologic testing: Acute phase...40% Convalescent phase .....66% “Course of Antibody Response in Lyme Borreliosis Patients before and after Therapy” Elisabeth Aberer and Gerold Schwantzer, Immunology 2012 IgG antibody response Before (BT) and after(AT) treatment LYME/Borrelia Labs • Direct tests: – PCR- DNA identification, low yield, tissue better than fluids – Borrelia Culture- promising new technique developed- study: 96%sensitive, definitive if positive. Improved culture conditions for the growth and detection of borrelia from human serum. Sapi E, Pabbati N, Datar A, Davies EM, Rattelle A, Kuo BA. Int J Med Sci. 2013;10(4):362-76 – Biopsy (high yield in animal studies)- silver stain, IHC Multiple lesions=disseminated dz Lyme Disease: a Neuropsychiatric Illness • “A broad range of psychiatric reactions have been associated with Lyme disease including paranoia, dementia, schizophrenia, bipolar disorder, panic attacks, major depression, anorexia nervosa, and obsessive compulsive disorder.” Fallon BA, Nields JA. Columbia Univ. American Journal of Psychiatry, 151(11):1571-83. 1994 Great resource: www.lymeinfo.net “literature summaries” SPECT in Late Stage Neuroborreliosis Control Donta ST, Noto RB, Vento JA. Clin Nucl Med. 2012 Sep;37(9):e219-22.. SPECT brain imaging in chronic Lyme disease- 75% w abnl SPECT scans, 70% improved w prolonged abx Other issues • Prior treatment with antibiotics: – ***Can attenuate antibody response • More likely to test negative, possibly forever. • There is ***no “test for cure” • Treatment Delayworse outcome – If >60days from onset to treatment 6x more likely to remain ill – If ECM+ 5x more likely cured w treatment • Cameron D, 2006 Journal of Evaluation in Clinical Practice Multiple Pathogens in ticks: • “PCR analysis of Ixodes scapularis ticks collected in New Jersey identified infections with – Borrelia burgdorferi (33.6%), – Babesia microti (8.4%), – Anaplasma phagocytophila [Ehrlichiosis] (1.9%), – Bartonella spp. (34.5%).” • • Adelson ME, et al, J Clin Microbiol 2004 . Bartonella spp. bacteremia and rheumatic symptoms in patients from Lyme disease-endemic region. Maggi RG, et al,Emerg Infect Dis. 2012 May;18(5):783-91 – 40% of patients PCR+ for Bartonella (Galaxy Diagnostics) biofilm “The influence of systemic inflammation on inflammation in the brain: implications for chronic neurodegenerative disease” Perry H;Brain,Behavior, and Immunity 18(2004) 407-413 • “…systemic inflammation may impact on local inflammation in the diseased brain leading to exaggerated synthesis of inflammatory cytokines and other mediators in the brain, which in turn influence behavior. These interactions suggest that systemic infections, or indeed any systemic challenge that promotes a systemic inflammatory response, may contribute to the outcome or progression of chronic neurodegenerative disease.” Relationship of Inflammation and Autoimmunity to Psychiatric Sequelae in Lyme Disease Bransfield R, PSYCHIATRIC ANNALS 42:9 | SEPTEMBER 2012 • LATE-STAGE IMMUNE CNS EFFECTS: three principal mechanisms leading to the injury of neuronal cells are: – 1) the secretion of cytotoxic substances by leucocytes and glial cells – 2) direct cytotoxicity – 3) autoimmune-triggered processes via molecular mimicry. – “No self-perpetuating immune process without persistent infection has ever been scientifically proven.” Microglial priming: (microgliaWBC’s of the brain) • “Pre-existing microglial activation greatly magnifies neurodegeneration associated with subsequent episodes of immune activation” • Blaylock RL, Strunecka A; Immune-Glutamatergic Dysfunction as a Central Mechanism of the Autism Spectrum Disorders, Curr. Medicinal Chemistry, 2009,16,157-170. • An inflammed brain(body) is highly sensitive/vulnerable to further inflammatory insultmagnified response • Bite of pizza bite the teacher Peripheral infection (?and any other peripheral immune challenge?) can trigger CNS pathology • Mice: – Infected w CNS restricted Measles virus- no illness – Infected w peripherally restricted (LCMV) virus- no illness – Infected with both: ALL became diseased with 50% mortality and most having seizures • 12 fold increase activated Tcells in brain, inflammation/edema • >35% where LCMV specific (despite NO LCMV in brain tissue) • i.e.- CNS activator and recruiting signal + peripheral immune response initiator= potentiated neuroinflammation • “CNS Recruitment of CD8+ T Lymphocytes Specific for a Peripheral Virus Infection Triggers Neuropathogenesis during Polymicrobial Challenge” Matullo CM, et al, 2011, PLoS Pathog 7(12) PeripheralCNS cont’d • “These results indicate that T cell trafficking can be influenced by other ongoing immune challenges, and that CD8 + T cell recruitment to the brain can trigger CNS disease in the apparent absence of cognate antigen. • By extrapolation, human CNS diseases of unknown etiology need not be associated with infection with any particular agent; rather, a condition that compromises and activates the blood-brain barrier and adjacent brain parenchyma can render the CNS susceptible to pathogen-independent immune attack.” Matullo CM Cytokine Associated Emotional and Cognitive Disturbances in Humans, Arch Gen Psychiatry. 2001;58: 445-52, Reichenberg A, et al • “Infectious, autoimmune and neurodegenerative diseases are associated with profound psychological disturbances.” – Study: inject low-dose salmonella endotoxin (not enough to give any subjective sense of illness, but enough to induce transient inflammatory cytokine release) or placebo…tested repeatedly over next 10hrs • Within 1 hour: new onset of anxiety, depression, reduced memory • “…mild stimulation of primary host defense has negative effects on emotional and memory functions.” Infection and Autoimmunity“Infections and autoimmunity - friends or foes?”, Shaye Kivity, et al. Trends in Immunology 2009. • “…not always a hit and run event, but rather a cumulative process. The immune system is affected by repeated infections from childhood, and in immune sensitive individuals, a breakthrough point might occur when the infection burden crosses a crucial level. This breakthrough point might be reached when a specific pathogen load, immune load or a unique combination of pathogens is established.” Synergy of Factors: -Heavy metals and 1000’s of other toxins: – “…profound and complex effects on the immune system…subtoxic doses of mercury induces both the production of highly specific autoantibodies and a polyclonal activation of the immune system” Mol Immunol. 2005 May;42(7):833-8 – Mercury + PCB’s magnified neurobehavioral effects, Lead + Mercury 1+1= 50 -Massive nutritional shifts over time: refined (carbs), toxic, nutrient devoid food -energetic- EMF’s, societal, etc… Nutritional immunology “Minocycline, a microglial inhibitor, reduces ‘honey trap’ risk in human economic exchange” • • “Males tend to cooperate with physically attractive females without careful evaluation of their trustworthiness, resulting in betrayal by the female. In this experiment, healthy male participants made risky choices (whether or not to trust female partners, identified only by photograph, who had decided in advance to exploit the male participants). The results show that trusting behaviour in male participants significantly increased in relation to the perceived attractiveness of the female partner, but that attractiveness did not impact trusting behaviour in the minocycline group. • Scientific Reports 3, Watabe et al, 18 April 2013 SYNERGY: mercury is in the backgroundreduced ability to clear microbes Dynamics in treating the chronically ill: Strengthen, Optimize Terrain Reduce Parasitic Microbial Burden Anti-oxidant- Pro-oxidant- Symptoms… but ? microbial clearance Symptoms… but ? microbial clearance Stratifying Patients: • Acutely ill- a “golden window”, especially with lyme borreliosis to completely and definitively treat and prevent chronic illness – Treat the infection component early and completely (adequate dosing and duration) – Rapidly dividing infection(s)- more antibiotic responsive – Patient usually doesn’t need much co-factor work (if preexisting health was high) • Chronically ill– Sometimes may do better with “strengthening” and addressing some co-factors first, before direct antimicrobials, but you may only get so far without going after the “infection(s)” Strengthen,Optimize Terrain &/or Reduce Parasitic Microbial Burden • Reduce Microbial Burden emphasis: – – – – Severely ill and/or rapidly declining, children Acute decompensation High level of prior health • Terrain emphasis: – Long-term ill, “stable”-chronic persistent state, – adults, – not rapidly declining – (probiotics, remineralize, omega-3, B-12, micro/macro nutrients, hormone balancing, diet, emotions…) • Many concurrently General Differences: • Pediatric: – **Respond better to antibiotic therapy- more likely to heal with this single intervention. – Harder to elicit symptoms (and assess treatment response) – More gastrointestinal symptoms, headache – Relapses usually occur rapidly • Adults: – More difficult to treat – More co-factors (dysfunction of immune/endocrine/ neurologic systems, additional accumulated pathogens, accumulated toxins) – Relapses slower and less defined Evaluation: most• Testing: – CBC, Comp. Metabolic, B-12, ANA, RF, ESR – IgG: gluten, casein (others- soy, corn, egg) • And/or elimination trial even w NL labs – GI- stool analysis w parasitology – Thyroid eval- TSH, free T3, free T4, thyroid Ab’s – Eval celiac- anti-transglutaminase, anti-gliadin IgA, total IgA – Toxin- urinary porphyrin &/or dmsa provoked urine and/or MELISA – Mold- ERMI test on home – Electrodiagnostics, ZYTO, ART, others – TGF-Beta1, C4a ? – Etc… Specifics- infection evaluation • Borrelia (“lyme”)- western blot- with complete band analysis, sometimes treat first then test/re-test, PCR(tissue>fluids), new culture test (Advanced Laboratories), with biopsy- do pcr, silver stain and IHC • Usually: – Babesia- titers, also FISH (Igenex) , and Duncani/WA-1, (Immunosciences) – Bartonella-titers, pcr (enriched culture pcr- Galaxy); with biopsy- do: PCR, IHC and silver stain – Ehrlichia and Anaplasma titers • Occasional: – Mycoplasma- PCR (tissue, blood, urine; MDL, Clongen), Mycoplasma Pneumonia Ab, others – Fry labs blood smear- ?organism? – Others…chlamydia Ab, viral titers, etc… • Avoid Tunnel Vision- check other non-infectious possibilities- Total microbial load – Treatment sequence: start with large organisms and move toward small Big • Worms • Yeast • Protozoa • Bacteria Small • viruses (Synergists: licorice, ginger, blk pepper(piperine) Herbal: black walnut, garlic, etc… Pharma: Alinia, albendazole, biltricide Herbal: probiotics, caprylic acid, garlic, Oregano, etc… Pharm: fluconazole, itraconazole…. Herbal: Mora, Cryptolepis, Sida acuta… Pharm: Mepron/zithr, ?Alinia…. Herbal: multitude Pharma: multitude Often pushed into dormancy once above addressed, Olive leaf extr., mult combo’s Pharm- ?valtrex, etc.. Microbial reduction/suppression/balancing: • Pharmaceutical antibiotics – Variable responses- life-saving in some, not in others – May induce reactive pleomorphism, dormancy and yeast dominance • Botanical: – slower, more subtle…requires patience, sometimes 2-3+mos. to start seeing improvement – 6-8 different ones I use (japanese knotweed Resveratrol- inhibits TNF-alpha and downregulates NF kappa B),, cumanda, banderol, smilax, artemesia, red root, samento, stephania, sida, etc…) – Alone or in combinations – Constant and/or rotational- cycling- 6-8wks on- 2wk off then change, 12 day on/2off, – Watch Liver enzymes if given with ABX “Lyme Tea” Lyme tea table (optional) Combine herbs and water in a large stockpot. Stir, cover and bring to a boil, then lower heat and simmer for 2 hours. Strain (use a mesh strainer covered with cheese cloth ) and pour into a clean canning jar, wine bottle, glass bottle or use an iced tea jug w/spigot. Store in the fridge. Compost herb . General dosage guideline: about 3-4 ounces 3 times a day, adjust dose base on tolerance; reduce dose in children (use only under supervision of physician/herbalist,etc) Anti-microbials/microbial balancers: • Pharmaceutical – Most effective/useful: • rapidly dividing/escalating illness • Heavy neurologic involvement • Early acute illness • Children • Elderly • Fewer co-factors • Good pre-existing vitality • Botanical: – Most effective/useful: • Slow smoldering illness • Prior heavy anti-biotic use and have stopped responding, relapsing • Prolonged illness • Adults • Many co-factors • Weak/depleted vitality Antimicrobial techniques: • Dealing with “Adaptation”: (if happens, generally see in the 26mos time-frame with both herbal/pharma) – “cycling”- 6-8wks with a given therapy, stop for 3-4wks or until highly symptomatic, then go to next therapy • *however, if getting progressive continued slope of improvement, may be best to hold the current course – Proteolytic enzymes- lumbrokinase, serrapeptase, nattokinase- most effective if give after been on antimicrobials for several weeks – “cyst” busting anti-microbials AFTER on others and give course every 2-4wks (flagyl/tindamax, GSE, plaquenil…) – Poly-pharmacy: poly-botanical, poly-pharmaceutical, botanical-pharmaceutical – “pulsing”- on and off, same therapy- eg 3 days in row/wk. Finding blocks and rate-limiting-steps • Some common obstacles: – Food sensitivities: Gluten>Casein>soy>corn • IgG reactions….add fuel to the fire – Untreated intestinal parasites – Untreated/imbalanced systemic parasites (bacteria/yeast/protozoa/viral) – Inflammatory nutritional excesses- ex: refined carbohydrates – Emotional/relational/spiritual discord – Ongoing Mold exposure (in a sensitive pt.) – Unmediated/ongoing toxin exposures – Sleep and rest – Keep: looking, reassessing, therapeutic trials – Some may not be destined for healing Cases: Being Healthy Is a Revolutionary Act: A Manifesto for Thriving in a Mixed-Up World • By Pilar Gerasimo, www.RevolutionaryAct.com • “In case you haven’t noticed, we live in a society where the idea of health and fitness is wildly popular, but where actually becoming a truly healthy person can be mighty tough to pull off. • There’s a reason so many of us are sick, overweight, depressed and stressed out: We’re living in a society that is wired up to make us sick, overweight, depressed and stressed out. • We can change this mixed-up reality. We can reclaim our well-being and create a better, more blissful world. But it’s going to take some revolutionary moxie to make it happen.” Empowerment and Transformation…vs. fear and anger • Re-claim responsibility for healing your life • Relentlessly forces one to face the realities of one’s life: priorities, choices, knowledge of what strengthens you and what weakens you • -become exquisitely sensitive to one’s internal and external world…sound, touch, food, relationships…insight and spiritual experience. •The healing journey…can be a journey of selfexploration, heightened awareness, empowerment and transformation End- Thank You