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Orceyre CIM.Pdf 5/21/2018 Complementary and Integrative Medicine: What Are My Options? Deirdre Orceyre ND MSOM LAc Naturopathic Medical Director, GW Center for Integrative Medicine • No Financial Disclosures Naturopatic Physician, Acupuncturist, GW Comp. Breast Center Adjunct Assistant Professor, Georgetown University May 19, 2018 • 2 Introduction Overview (who I am) ★ Naturopathic physician and licensed ● Introduction to complementary medicine practitioner of Chinese medicine ● Biologic adjunctive therapies: ○ 6 years of naturopathic medical school ○ Mushrooms ○ 2 years naturopathic residency ○ Melatonin ★ Trained as general practitioner ○ Green Tea ○ Laboratory diagnosis ○ Vitamins C and K2 ○ Physical exam ○ et al ○ Prescription drugs ● Diet: Realistic Evidence Based approach ○ Minor surgery ● Underlying systemic functional issues: ★ General practitioner of holistic medicine ○ Gluten Sensitivity ○ Nutrition, Nature Cure, lifestyle, botanicals, ○ MTHFR mutations, homeopathy, supplements, flower essences, ○ Phase I or II liver detox genetic abnormalities, manipulation, exercise, acupuncture ○ Poor Stress Resilency Dr. Deirdre Orceyre - www.drorceyre.com 4 Complementary and Overview Alternative Medicine (CAM) ● Wellness approaches to minimize side effects of disease ★ Complementary medicine is used with conventional and chemotherapy: ○ Tai Chi medicine. ○ Mindfulness Practices ○ Example: Acupuncture to reduce fatigue from ● Meditation radiation therapy ● Biofeedback ● Yoga ★ Alternative medicine is used in place of conventional ● Acupuncture medicine. ● Other ideas ○ Example: Taking “anti-cancer” supplements instead ● Tips on navigating CAM world of undergoing radiation therapy ● References: ○ Books ○ Online Resource 5 6 Dr. Deirdre Orceyre Slide contributed by Sarah M. Rausch, PhD,AA&MDSIF LP March 28 2015 1 5/21/2018 Integrative Medicine What percentage of cancer patients report using CAM? ● Integrates complementary therapies with evidence of safety and effectiveness into conventional medical treatment with goals of: •62% long-term Lymphoma survivors use CAM •73% of hospitalized cancer patients use CAM ● optimizing health promotion •44% of German Leukemia patients use CAM, ● preventing disease with >half not disclosing to healthcare team ● improving patient outcomes ● managing symptoms ● improving quality of life Slide contributed by Sarah M. Rausch, PhD, LP 7 Dr. Deirdre Orceyre AA&MDSIF March 28 2015 Slide made by Sarah M. Rausch, PhD, LP Integrative Medicine in Cancer Survivors Review of clinical studies from 2016 only National Cancer Institute (NCI) has incorporated a focus on complementary care for cancer survivors into their strategic plan (2014) JNCI Monographs on integrative oncology “National Center for Complementary and Alternative Medicine has decided ...to focus ... resources on research on benefits and risk of complementary health practices for symptom management…” 2015 - NCCAM becomes NCCIH (from CAM to Integrated Health) Viscuse PV, Price K, Millstine D, Bhagra A, Bauer B, Ruddy KJ. Integrative medicine in cancer survivors. Curr Opin Oncol. Briggs J. Building the Evidence Base for Integrative Approaches to Care of Cancer Survivors. Journal of the National 2017 Jul;29(4):235-242. doi: 10.1097/CCO.0000000000000376. PubMed PMID: 28459738. Cancer Institute Monographs. 2014;2014(50):288. doi:10.1093/jncimonographs/lgu040. J Canc Educ (2016) 31:47–54 DOI 10.1007/s13187-014-0785-9 A Wellness Program for Cancer Survivors and Caregivers: Developing an Integrative Pilot Program with Exercise, Nutrition, and Complementary Medicine Mark Stoutenberg & Alyssa Sogor & Kris Arheart & Stacy E. Cutrono & Julie Kornfeld • Many oncology centers are exploring integrative therapy programs for survivorship 10-wk Integrative Wellness Program (IWP) - instruction in exercise, nutrition, and complementary and alternative medicine Questionaires - physical activity levels, dietary habits, sleep hygiene, and quality of life 2 5/21/2018 J Canc Educ (2016) 31:47–54 DOI 10.1007/s13187-014-0785-9 Levels of Evidence A Wellness Program for Cancer Survivors and Caregivers: Developing an Integrative Pilot Program with Exercise, Nutrition, and Complementary Medicine Mark Stoutenberg & Alyssa Sogor & Kris Arheart & Stacy E. Cutrono & • Level I - Well designed randomized controlled trials Julie Kornfeld “comprehensive programs for cancer survivors should • Level II – Prospective or retrospective non- incorporate exercise, nutrition, and CAM practices to randomized clinical trials and analyses improve health behaviors and potentially long-term health outcomes.” • Level III – Opinions of expert committees, best case series “promising results regarding the effectiveness of the program on improving dietary behaviors and other • Level IV – Preclinical in vitro and in vivo studies, and personal wellness characteristics...and had a great traditional uses deal of applicability and content value to the participants.” 14 Biological Adjunctive Therapies Green Tea (Biologics) • Levels I, II, III, IV • High in bioflavonoid antioxidants ● Green Tea • Also contains tannins, minerals, caffeine and L- ● Boswellia Theanine ● Omega 3 (Fish Oil)/ Omega 6 (Flax seeds/oil) • 2015 epidemiological study in China - green tea ● Medicinal Mushrooms drinking associated with decreased risk of developing ● Curcumin MDS. Leukemia Research 39 (2015) 164–169 ● Melatonin • Induces apoptosis (cell death) in hematologic tumor ● Vitamin K2 cells in vitro Haematologica, 2005 Mar;90(3):317-25. ● Vitamin D • Almost all studies are done on dietary intake with ● High-Dose Vitamin C I(V) typical “high intake” considered to be 5 or more cups per day 15 16 Green Tea Green Tea • Try to get organic (not organic is likely to contain high amounts of pesticides) • If want to take supplement Risk of hematologic malignancies was inversely associated with • high quality is important green tea consumption. The multivariate-adjusted hazard ratio of hematologic malignancies for 5 cups/day or more compared • Typical dose is one 300-500mg capsule twice daily (each with less than 1 cup/day of green tea was 0.58 (95% confidence containing at least 50% EGCG) (usual cost - $15- interval: 0.37, 0.89). The corresponding risk estimate was 0.52 20/month) (95% confidence interval: 0.31, 0.87) for lymphoid neoplasms and • Capsules are actually cheaper than drinking high 0.76 (95% confidence interval: 0.32, 1.78) for myeloid neoplasms. quality(organic) green tea at studied doses - 5-6 cups/day Am J Epidemiol. 2009 Sep 15;170(6):730-8. 17 18 3 5/21/2018 EGCG and CLL Boswellia (Chronic Lymphocytic Leukemia) • 2 recent Randomized Control Trials on CLL (Rai Stages 0-2) • Boswellic Acid acetate – grade III, IV • Polyphenon E – concentrated green tea with EGCG content 400- 4000mg/day in twice daily dosing (200-2000mg) • Induces differentiation and apoptosis of human • About 70% of patients had WBC reduction of 10% or more and about leukemia lines 40% 20% or more • Very potent anti-inflammatory • Dose dependent side effects were common at higher doses: nausea, rashes. Some patients had to stop high dose • J Clin Oncol. 2009 August 10; 27(23): 3808–3814. • Very low side effect profile • Cancer. 2013 Jan 15;119(2):363-70 • Quality is important • Currently available products contain about 200mg of EGCG/capsule • Leuk Res 1999; 23;43-50 – at 10 capsules/day cost is about $50/month 19 20 Curcumin Japanese Mushrooms • Levels I, II, III, IV • Curcumin is an active ingredient of Turmeric • Examples: Reishi, Shiitake, Maitake, (curcuma longa) Coriolus • Levels II, III, IV • Traditional chinese medicine use • Modulates inflammation by down-regulating • Coriolus Versicolor aka Asian COX2 – nature’s Motrin "Turkey Tail” – best evidenced in • Inhibits TNF-Alpha, IL1, 2, 6, 8, and 12 general (PSK, PSP) DO NOT USE WITHOUT • Maitake - 2015 study with MDS GUIDANCE – Protocols are • Natural part of many world diets, especially India Cancer Immunol Immunother (2015) 64:237–247 complicated, often include and Thailand • Water extracts are best mixes of all or some of the above, often on/off regimens, quality is critical 21 22 Dr. Deirdre Orceyre AA&MDSIF March 28 2015 Dr. Deirdre Orceyre AA&MDSIF March 28 2015 Curcumin Melatonin • Induces cell death in human leukemia cells and • Levels I, II, III, IV stem cells. • Sleep hormone, synthesized by the pineal gland Biochim Biophys Acta 1996 Nov15;1317(2):95-100. Oncol Rep 2016. PMID: PMC5001835. • Also appears to be a strong anti-oxidant and regulates secretion of growth hormone and other hormones • Small positive clinical trials for Pancreatic, Colon Clin Cancer Research, 2008 Jul 15;14(14):4491-9 • Clin Gastroenterol Hepatol., 2006 Aug;4(8):1035-8. Epub 2006 Jun 6. Older positive study with chemo induced MDS J Pineal Res. 1990;8(4):347-54 • Absorption is increased with fats and black pepper • Recent Meta-analysis (total of 21 randomized trials) showed 37% reduction in all cause 1 year mortality in • Careful during chemo - only with guidance patients with solid tumors Cancer Res 2002 Jul 1;62(13):3868-75 Integr Cancer Ther. 2011 Oct 21 Mol Cancer Ther. 2006 Apr;5(4):952-61 • Usual dose 20mg at bedtime, start at no more then 5mg and • Typical dose - 1000mg twice daily of concentrated slowly increase over 3-4 weeks extract 23 24 Dr. Deirdre Orceyre AA&MDSIF March 28 2015 Dr. Deirdre Orceyre AA&MDSIF March 28 2015 4 5/21/2018 Vitamin K2 • Levels I, II, III, IV – clear evidence for MDS, both clinical trials and laboratory research • Does not affect clotting, important primarily in bone and muscle health • Similarly
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