IntegrativeMedicine GeneticsandLifestyleforCognitive
HealthInstituteforIntegralHealth,LLC
MaryAnnOsborne,DNP,FNP
Objectives● DiscusstheAPOEGeneandit’slinktochronicdisease
● Demonstrateknowledgeoflifestyleandbrainhealth
● IdentifythesubtypesofAlzheimer’sDisease
● DiscussissueswithcaregiversofAlzheimer’sclients
MyJourney● Near-Deathexperienceatage7
● HolisticBSNprogram
● JoinedArmyNurseCorps
● ArmyNursePractitioner–1986(AdultNP)
● Master’swithcommunityfocus–1991(FNP)
● IntegrativeMedicineFellow–2003
● DoctorofNursePractice–2010
● IndependentPractice-2005
TippingPoint
Personal&FamilyCrisis
PrograminIntegrativeMedicine● UniversityofArizonaSchoolofMedicine
● 1994IMFellowship–Residential
● 2000ResidentialandHybridDistance
● 20031stNursePractitionergraduated
● AnnualNutritionandHealthConference
● Onlineprograms,IntegrativeHealthLifestyleprogram
(IHeLp),IntegrativeHealthCoaching
● FreeEnvironmentalHealthcourse
● Integrativemedicine.az.edu
IntegrativeMedicine● Ishealing-orientedmedicinethat
takesaccountofthewholeperson
(body,mind,andspirit),including
allaspectsoflifestyle.
● Itemphasizesthetherapeutic
relationshipandmakesuseofall
appropriatetherapies,both
conventionalandalternative.
Dr.AndrewWeil
PrinciplesofIntegrativeMedicine● 1.Apartnershipbetweenpatientandpractitionerinthehealingprocess.TwoExperts
2.Appropriateuseofconventionalandalternativemethodstofacilitatethebody'sinnatehealingresponse.
3.Considerationofallfactorsthatinfluencehealth,wellnessanddisease,includingmind,spirit
andcommunityaswellasthephysicalbody.
PrinciplesofIntegrativeMedicine● 4.Aphilosophythatneitherrejectsconventionalmedicinenoracceptsalternativetherapiesuncritically.
● 5.Recognitionthatgoodmedicineshouldbe
basedingoodscience,beinquirydriven,andbeopentonewparadigms.
6.Useofnatural,effective,less-invasiveinterventionswheneverpossible.
IntegrativeMedicine● InaNutshell:
●Allowingtimeandspaceto
understandthepatient’sstoryand
fosteradeeperunderstandingand
connectionwithourpatients.
MyTransformation● Contemplationandreflection
● Journaling
● ExtremeSelf-Care
● SpiritualReflectionandConnection
● Relaxation;breathing,yoga,
● MindfulnessMeditation
● EnergyWork
● PhysicalActivity
● Healthfuleating
● Vitamins;MedicinalMushrooms;supplements
Hadmyupsanddownswith
dryspells
DiscoveredtheApoEGeneSolutionfor
TurningOffDisease
StateofHealthWhyknowaboutgeneticsandepigenetics?
15
LeadingCausesofDeathin1900
LeadingCausesofDeath2017● Heartdisease:633,842 •Cancer:595,930•Chroniclowerrespiratorydiseases:155,041•Accidents(unintentionalinjuries):146,571•Stroke(cerebrovasculardiseases):140,323•Alzheimer’sdisease:110,561•Diabetes:79,535•Influenzaandpneumonia:57,062 •Nephritis,nephroticsyndrome,andnephrosis:49,959 •Intentionalself-harm(suicide):4,193
● CDC2017
Problem:Confusion
MultipleFactors:Confusion● DietIndustry---FADDiets
● ADANutritionSurvey–Showed
● StockMarketChanged
● ProfitfocusedCorporations;ChangeinFarming
Practices;IncreaseinGMO’s
● FarmBill–increasefoodcaloriesfrom3200Kcalto
3500Kcalforeveryman,woman,child
WeEatEverywhere!
Genetics● Geneticcodecompletedin2003
● Genetictestingismoreaffordablethanever
● GeneticandEpigeneticresearchshowinglinkbetween
lifestyleanddisease.
Epigenetics● Physically:Epireferstothesheathofproteinsand
chemicalsthatcushionandmodifyeachstrandof
DNA.
●Malleableandfluid
● EntireamountofepigeneticmodificationoftheDNA
inyourbodyiscalledtheepigenome
● Exciting!It’sHereGenesgetturned“onoroff”
●WecancontroltheswitchwithBalanceofMind
BodySpirit
Genetics
ApoEGene
Providesatransportsysteminthe
humanbody-mainlyforfatand
cholesterol
APOEGene● ThoughttobeMainGeneofBody
Discoveredin1973byLawrenceBerkeleyNationalLab
ResearchedattheGladstoneInstituteUCSF-SanFrancisco.
Discoveredfirstfor:Type111hyperlipidemiaAPOE2/2
APOEGeneandAlzheimer’s1992-1995AllenD.Roses,MD&hiscolleaguesconnectedtheApoEGenetoAlzheimer’sDiseaseatDukeUniversity
CardiovascularDiseaseandAlzheimer’s
●Alzheimer'sandCardiovasculardisease
arebothinflammatorydiseases
connectedbythesamemarkers
ApoEGeneLongevity● ApoEGene4allele–7millionyearsago
● ApoEGene3allele–220,000yearsago
● ApoEGene2allele–80,000yearsago
Environment
●External:Includeseverythingthatsurroundsyou
●Internalspace:physical,emotional,social,
andspiritual
● Doyoulive/workinhealing
environments?
ArteryPenetrationofLDL
HeartDiseaseProgression
Alzheimer’s
●SimilarProcesstoCVD?
●ChronicIllnessindicatesinflammation
andimbalance
CognitiveDecline● 5.4millionAmericanpatients
● 30millionaffectedglobally
● 13millionAmericanby2050
● 160millionglobally
● 3rdleadingcauseofdeathintheU.S.(James,B.D.etal.
ContributionofAlzheimerdiseasetomortalityintheUnitedStates.
Neurology82,1045-1050,doi:10.1212/WNL.0240(2014)
CostofAlzheimer’sSignificant cost related to Alzheimer's estimated $259 billion in 2017.
Not included $94 billion in unpaid services to an estimated 10 Million caregivers.
An increase in Alzheimer’s disease by 47 % in 6 years
AFemaleEpidemic● 65%ofpatientsarewomen
● 60%Caregivers
● MorecommonthanbreastcancerintheU.S.
ADEpidemic
●30,000,000in2012
●160,000,000in2050●Untilnowverylittletherapeuticallytooffer
WhatCausesAlzheimers?
ConventionalAttitude “Thereisnothingthatwillprevent,reverse,orslowtheprogressofAlzheimer’sdisease.”
BredesenAttitude
Somedaysooneveryonewillknowan
Alzheimer’ssurvivor
BredesenProtocol● DrDaleBredesen
● BuckInstituteforResearchonAging,Novato,CA
● Failureofmonotherapies
● Multiplepathogenictargetsforpotentialdrugs
● Chronicillnesssignalsimbalance/inflammation
BredesenProtocol● Aroofwith36holes
● OrganismsproduceAmyloidplaqueinresponseto3
majormetabolicandtoxicdisturbances
● Inflammation(canbefrominfectionorlifestyle)
● Withdrawaloftrophicsupport(VitaminD,estradiol,
testosterone,etc)
● Exposuretotoxins(heavymetals,mercury)
● Sleepapnea,trauma,vascularinsufficiency
TypesofAD● Type1:Inflammation;APOE4gene
● 1.5Glycotoxic:insulinresistance,APOE4
● Type2:Non-Inflammatory/Atrophic;APOE4;
metabolicabnormalities;lossofhormones,vitamin
deficiencies
● Type3:Toxic;APOE4negative(usually);<65onset;
mostdifficulttotreat;causeisinfection,traumaor
LeweyBody
TypesofAD● Type4:Vascular
● Type5:Traumatic
AD● Verycommontohaveacombinationoftypes
● Forexampleglycotoxic(type1.5),inwhichthe
advancedglycationendproducts(AGEs)cause
inflammationandtheinsulinresistanceleadsto
trophicwithdrawalsignaling
● Otherinputssuchassleepapnea,trauma,andvascular
insufficiencytriggeramyloidviathesesame3major
causes.
ReCODEProtocol● Mappedthemanymolecularmechanismsofcognitive
declineandADontoatreatmentprotocol.
● Includesdozensofinterventions,beginningwith
DESS,hormonaloptimization,nutrients,targeted
herbs,brainstimulation,drugs,etc.
● Nooneinterventionclosesall36holes
● Approach:pulloutallofthestops
ReCODEProtocol● “Alzheimer’sdisease”isapathologist’sdiagnosis.This
termshouldnotbefollowedbyaperiodanymorethan
fevershouldbe—Alzheimer’sdiseaseduetowhat?
●Whatisreferredtoas“Alzheimer’sdisease”isactuallya
protectiveresponseto3majormetabolicandtoxic
insults:inflammation/infection,trophicwithdrawal,
andtoxinexposure
ReCODEProtocol● Inflammation:resolution(resolvins),inhibition,
removalofsource(s).
● Infections(chronic):Borrelia,othertick-borne,chronic
viruses,etc..
● Atrophic:optimizationofhormones,homocysteine,
methylation,trophicsupport,antioxidants,etal.
● Toxins:metalsincludingCu:Znratio,Hg;mycotoxins.
● Metabolismincludingglycotoxicity(type1.5).
● Regeneration,protection.
BasicConcepts● Identifyallcontributorstotheimbalancedplasticity
network
● Determinethedegreeofcontributiontoeachtype
● Optimizethevalueofeachabnormality
● Addressasmanyoftheabnormalitiesaspossible,the
earlierintheprocessthebetterchanceforsuccess
● Designthetreatmenttobeasphysiologicaland
upstreamaspossible
● Personalize
RiskFactors● Sleepapnea
● Historyofheadtrauma
● Historyoflossofconsciousness
● Presenceofdentalamalgams
● Historyofhypertension
● Consumptionofseedoils
● Neuroactivemedications(especiallywithanticholinergic
activity),directorindirect:e.g.,benzodiazepines,statins,
protonpumpinhibitors,antipsychotics,antihistamines,
anesthetics,ETOH,illicitdrugs,etc.
67y.o.womanwith2-yrhistoryof
progressivecognitivedecline
● Motherdiedwithdementia,onsetage62.
● Unabletonavigateonfreeway.
● Couldnotrememberwhatshehadread.
● Unabletopreparereportsforwork.
● Unabletorecalleven4-digitnumbers.
● Retinalscanpositiveforamyloid
● TreatedwithMEND(metabolicenhancementfor
neurodegeneration).
Case1D.D.● 44yofemale,counselor,c/oforgetfulness,unabletofind
wordsandforgettingclientsnames.“Feelsitis
progressing”
● Feelsshe’saddictedtosugar
● Parentsarevisiting:Motherhasaveryhealthylifestyle
andFatherisa“junkeater”;neitherhavememory
change
● Statesthatwhentheyarevisitingthisisabarriertoher
changingherlifestyle.
● Mostlysedentarywithoccasionalhike
Case1D.D.
● ApoEGenetestresults:¾
● Recommendeddietarychanges:initiallyavoiddairy
andredmeat.Eatgoodfatssuchasavocado,oliveoil;
basicallygaveherbabystepsduetoherresistance
● Dailyexercise:75%aerobic(sweatingisherfriend)
● Reviewedhistory:lowriskinfectionorheavymetal
toxicity.Probableleakygut
● Elevatedglucose(98);TSH3.35
● BeganNatureThroid;Berberinesupplement;initially
MCToilandincreaseingoodfats
Case1D.D.● InitiallyDDresistedchangefor6months
● Hadshifttobegincaringforherselfandbegandietary
changes;dailywalking;fasting3hoursbeforebedtime;
begantotal12hourfast
●Within8weeksLost17pounds;memoryissues
resolved
● ShechosenottoenrollinReCODEandwehavenot
completedtheevaluation
● Greatexampleofearlieryoutreatthebetter!
Theprotocolworksbestfor:● Presymptomatics(cf.7millionE4/4,75millionE4)
● SCI(subjectivecognitiveimpairment)
● MCI,especiallyifaMCIandidentifiablecontributors
● Peoplewithcognitivechangeswhoareotherwisehealthy.
● EarlyAD,especiallyifnotalreadyondonepezilor
memantine
● Theprotocolworksbestfor:•Non-type3SCI,MCI,orearly
AD
● Atrophylimitedtohippocampus
● Age<75
MentalHealthProfessional● ExtremelyimportanttofindMHPthatoffers
NeuroPsychtesting
● Communicationbetweenproviders
● Assistancewithevaluatingsafetyofclient
● Assistanceinevaluatinghistoryoftraumaandother
co-morbiddisease(i.e.depression)
● Supportforfamily
RiskFactors● PoorOralHygieneRootCanalsPeriodontalDs
● Sinusitis
● MetabolicSyndrome
● HistoryofETOHwithdrawalsymptoms
● Historyofvasculardisease
● Exposuretomitochondrialtoxins(i.e.antibiotics,
statins,ApoE4,griseofulvin,AZT,acetaminophen,
NSAIDS,cocaine,methamphetamine,L-DOPA,
● BMI>25
● Renal,hepatic,orpulmonarydisease?
RiskFactors● Sleep<7hours/night?
● SeropositiveforHSV-1?
● Headaches?
● Moldexposure?
● Historyofmeningitis?
● Historyofcancer?
● Glutensensitivityorotherfoodsensitivity?
PeopleYouSeeatRisk● Depression
● Anxiety
● Insomnia
● CardiovascularDisease(youmayseeafterMI)
● Menopause
● 48yofemalewithhistoryoftrauma,developssevere
anxietyandadmittedtolocalmentalhealthhospital.
MDidentifiedthatsheneededtoconsultregardsHRT
Case2● 52yearoldmale,married,retiredAirForce
●WorksfulltimeforAFbutrecentlyhisbosscounseled
himonjobperformancerelatedtomemoryissues
●Wifeextremelysupportive
● Lovestowoodworkingandbuildingthingsinhisshop
Case2
Case2
Case2
Nutrition● Nutritionisthemostimportantaspectoftreatment
● Avoidsimplecarbs,saturatedfatsandlowfiberdiet
● Hardlyanyonepresentswithagooddiet
● Plantbased
● Majorityofcaloriesfromnon-starchyvegetables(best
local,organic)andgoodfats.Includecookedandraw
vegetables,darkgreen,rainbow,andcrucifers
● Includedetoxifyingvegetablessuchascilantro,
cruciferousvegetables
Nutrition● Lowglycemicfruits
● Nofruitjuice
● Fish:wildcaught,SMASHfish(salmon,mackerel,
anchovies,sardines,herring).AvoidfishwithhighHg
(long-lived,largemouth)
● Meatiscondiment:wildgame;grassfedgrassfinished● Pasteurizedeggsandpoultry
● Avoidgluten,dairy,othersensitivities
● DirtydozenandCleanFifteenewg.org
Case3● 72yearoldmale,divorced,retiredDentistwithonsetof
memorydeclineat62
● Memorydeclinehasexceleratedoverpast2years
● Hehaslovingrelationshipbutrecentlyshemovedout
duetohissiblingsgettingmoreinvolvedindecisions
● Nolongercandrive,dailycaregiver
● Stays4nightsatgirlfriend’shouse
Case3
Case3
BredesenProtocolHealGut
Sleepisessentialtohealing
Assessforsleepapnea
Menopausal?
Meditation
Breathing–4-7-8
NeuralAgilityiAwaketechnologies;Centerpointe
Holosync
Caregivers● Anxiety
● Support
● Notcoveredinprotocol
Spiritual● Joy!
●WhatfeedsyourSoul?
● DowhatyouLove!
● Missingpieceoftreatment?
GODMeditation Forgiveness
Harmony
HealthPrayer
Good Food Happiness
Laughter
Jealousy
fear
Gossip
Negative Thoughts
Attitudes and EmotionsAddictionsSelf Pity
Anger
Hatred
FromListeningandCommunicatingwithEnergy–Dr.GingerBowler
Definitions● Spirituality:aninherentaspectofeveryhumanbeing
thatrelatestotheAbsolute–thatdomainwherevalues
andmeaningexist;theplacewhereHopeexists.
● Religion:abodyofbeliefsandpracticesdefinedbya
communityorsocietytowhichitsadherentsmutually
subscribe
SpiritualityinPractice● Takequiettimeforyourselftogowithin
● Reflectinnature
● Dothingsthatconnectyouwithsomethinglargerthan
yourself
● PracticeGratitude
SpiritualHistory● Importantpartofunderstandingculturalcontextof
patient
● Mayaffectwhyapatientmakesachoice
● Maynotbeappropriateforfirstvisitbutessentialfor
longtermpatientcenteredrelationship
● Variousapproachestoobtainingspiritualhistory
● Cognitivedeclineinvolvesallfamilyandfriendsin
treatment.Whatistheirsupport?Values?Beliefs?
Self-Care● SelfReflection
● Journaling
● Meditation
● Challengingyourframeofreference
EverydayLife
ModelBeliefs
WalkYourPath
MakeYourSELFaPriority BalanceYourPsychological/EmotionalEnergy
ChangeyourThoughtsaboutCircumstances
ChineseSymbolforCrisisisSameassymbolfor
opportunity
TurnObstaclesintoOpportunities
LearntoLookattheBigPICTURE
TheMindfulPractitioner● Mindfulnessenhancesrelationship-centeredcare
● “Atherapisthastopracticebeingfullypresentandhas
tocultivatetheenergyofcompassioninordertobe
helpful.”
● ThichNhatHanh
Summary● IntegrativeApproachtoChronicDisease
● APOEGene
● BredesenProtocolforAlzheimer’scare
● 3casediscussions
● CareoftheCaregiver
● CareofthePractitioner
Engineeringtheoutsideworld
cancreatecomfortand
convenience.Onlyengineering
theinteriorcancreate
wellbeing.
Sadhguru
