Transcript An Introduction to Endobiogenie

INTRODUCTION TO
ENDOBIOGENY:
AN INTEGRATIVE
APPROACH TO MEDICINE
By:
Jean Claude Lapraz, MD
Kamyar M. Hedayat, MD
OBJECTIVES
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Introduce Endobiogeny and its component
elements:
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Detailed history
Detailed physical exam
Classical labs and imaging studies
Biology of Functions
Integrative assessment, then…
Therapeutic strategy
Example: application of the concepts of
Endobiogeny to the clinical condition of Polycystic
Ovarian Syndrome (PCOS)
Discuss opportunities to learn the Endobiogenic
method
VIGNETTE
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23 year old female presents with 4 year history of
oligomenorrhea, hirsutism, acne, failure to
conceive, 30 pounds weight gain.
Laboratory studies reveal low-normal TSH,
normal T3, T4, estradiol, dihydro-testosterone,
androstenedione, but elevated fasting blood
glucose.
Ultrasound of uterus, ovaries unremarkable
History suggests Polycystic Ovarian Disease, but
endocrine, radiological studies are normal. Does
this woman have an endocrine disorder or not?
INTRODUCTION
An introduction to the
Endobiogenic concept
A brief review of the history
of medicine and its schools
of thought
ENDOBIOGENY
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The integrative study of the functional
mechanisms of regulation of the organism in its
basic structure during homeostasis as well as its
functional response to internal and external
stressors:
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As a whole system
In its individual units of function
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core metabolism
cell, tissue and organ
in and of themselves and in relationship to each other
Endobiogeny evaluates the qualitative and
quantitative state of the human organism and its
internal milieu.
EXAMPLE:
QUANTITATIVE ASSESSMENT
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Consider a car factory to be like the ovaries. Does the
number of cars (amount of estrogen) produced tell you how
efficiently the factory (ovaries) is functioning or how well the
cars produced drive?
A quantitative assessment of productivity tells you how
many cars are being produced (serum estrogen levels), but
not how well those cars drive (endocrine and metabolic
activity of estrogen).
For example, if the output of cars meets demand, but the
gear shifter is faulty (altered estrogen-receptor binding),
each car carries fewer people than its normal capacity due to
decreased torque. In this case, more cars will be needed to
carry people.
“Normal” factory output for this company (body) is
insufficient to meet demand
EXAMPLE:
QUALITATIVE ASSESSMENT
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But what about a qualitative assessment? There
may be supply issues—not enough steel available.
The factory cannot produce cars without steel
(cholesterol as a precursor to estrogen production)
Perhaps there are not enough workers on the
assembly line (Follicle stimulating hormone) and
the workers present are over-worked and will soon
decline in productivity (pituitary stress).
Perhaps there are ample supplies and workers,
but the manager is inefficient (hypothalamus) in
managing the factory, not regulating supply and
demand issues.
EXAMPLE:
QUALITATIVE ASSESSMENT
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Perhaps the manager is efficient, but the workers
do not always follow his directives (altered
thresholds of responsiveness).
Thus, it is clear that both a quantitative and
qualitative assessment of physiological and
endocrine activity is necessary to properly
understand disease and health.
ENDOCRINE MANAGEMENT
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Thus, Endobiogeny views the endocrine system
as the manager of the body, the controller of
anabolism and catabolism—which is what life
itself is at every level from the cell to the
structure of the universe:
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destruction and reconstruction
expansion and contraction
growth and apoptosis
birth and death
LEVELS OF MANAGEMENT IN THE BODY
Internal terrain
Mind-Body
Mental-Emotional
Neurotransmitters
NeuroEndocrine
Endobiogeny
Cell
receptors
Standard
Medicine
Enzymes,
co-factors,
vitamins
Functional
Medicine
External Terrain
Environmental Medicine
Toxins, Microbes, Metals
PHILOSOPHY
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Endobiogeny integrates the rational and empirical
schools of medicine with philosophy to create a
single coherent system of medicine:
PHILOSOPHY: The Endobiogenic approach
begins with the ontology (reason for existence) of
structures and physiology
This leads to a logical approach to understanding
structural weaknesses in the organism as well as
determining the true cause of disease
RATIONALISM
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The rational school of medicine has been the
predominant Western school of medicine:
Relies on deductive reasoning, anatomy and
physiology as the basis of its approach to illness.
• Nosology: Patients are categorized by disease, and
diseases are categorized by symptoms
• Medications are chosen based on biochemical or
empirical effects on symptoms or physiological signs
such as blood pressure or laboratory measurements
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Biomedicine (Allopathy) is the best-known form of
rational medicine
Modern herbalism has rationalist tendencies
RATIONALISM (CONT.)
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Endobiogeny is based upon:
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Modern physiology and contemporary understanding of
neuro-endocrinology
Consideration of role of genetic polymorphisms,
environmental toxins, stress, cytokines, cells, organs,
and their products of metabolism in the origins of health
and illness.
Consideration that the organism contains in itself a
fundamental auto-pathogenicity (potential for a specific
disorder) which implies a particular risk of disease.
Endobiogeny considers the mechanistic, reductionistic
concepts of life insufficient to explain the complexity
of the human organism
Endobiogeny treats the person, not the disease, thus
rejecting standardized treatment protocols
EMPIRICISM
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Refers to a system of medicine where the
practitioner’s impression of illness and
assessment of the individual’s expression of
dysfunction is the basis of treatment.
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Empirical medicine considers the energetics of
the individual as well as the energetics of the
treatment
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Chinese medicine and Homeopathy are forms
of empirical medicine.
EMPIRICISM (CONT.)
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Endobiogeny shares an emphasis on detailed history
and careful physical exam to understand the unique
physical and emotional antecedents of disease and its
physiognomic expressions in the individual
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However, Endobiogeny seeks to find coherence in this
information through physiological explanations
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In sum, Endobiogeny is an integration that takes into
account various levels of the individual: physical,
emotional and mental, in their relationship with the
endocrine management of the body and everything
under its control with its regulatory mechanisms
INTEGRATION OF DATA
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Endobiogeny integrates:
History
• Physical Exam
• Laboratory data and imaging
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To reach a conclusion regarding the current,
dynamic physiological state of the individual in
order to formulate a treatment strategy which
addresses:
the identified imbalances individually
• as well as in their relationship to other imbalances
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TREATMENT OPTIONS
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Endobiogenic treatments consist of various
therapeutic elements based on their safety and
efficacy with no prejudice to the origin of the
treatment:
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Phytotherapeutic elements
Homeopathic elements
Pharmaceuticals elements: reasoned usage based on
severity of symptoms, of degree or lack of
compensatory physiology.
Physical manipulations: craniosacral, myofascial, etc.
Diet and Nutrition
Trace elements
Stress modification, hydrotherapy, acupuncture, etc.
INDIVIDUALIZED MEDICINE
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Endobiogeny is individualized medicine based on:
The patient’s symptomization of illness within the
context of the global functioning of the organism
• The physician’s determination of the signs of
physiological and endocrine dysfunction
• The physician’s objective assessment of endocrine
relationships
• The particular physical, physiological, psychological
and emotional realities of the individual.
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CONCLUSION
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Endobiogenic treatment is determined by the
totality of the person:
Static and dynamic aspects of the patient’s
constitution
• Etiology, ontology, and integration of symptoms
• Adaptive and maladaptive aspects of physiology
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THE ENDOBIOGENIC METHOD
PATIENT HISTORY
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HISTORY: A detailed history of antecedent
events, including perinatal history, childhood
personality, illnesses, vaccinations and important
emotional events is solicited to establish the
constitutional and functional endocrine state of
the patient.
Dietary preferences, sleep habits, dreams,
menstrual history, various aspects of behavior
and review of systems are explored to establish
neuro-endocrine patterns
The trajectory of structural hormonal imbalances
is followed throughout life, not just with respect
to the outward manifestation of illness and
dysfunction
PHYSICAL EXAM
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A detailed physical exam from head to toe
evaluates the phenotypic expression of neuroendocrine relationships
Because the endocrine system manages both the
structural integrity of the body as well as its
functional expression, one is able to look for the
phenotypic expressions of endocrine activity and
correlate it with the internal state of the patient
Many of these findings are easily explained by
classical endocrinological assessment of hormonal
activity
LABORATORY STUDIES
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Classical lab data is based on binary considerations:
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disease vs. no disease
normal vs. abnormal value
The patient in our vignette presented with normal
levels of all the relevant hormones. Can we conclude
that these hormones are functioning normally, or even
that their relative levels are appropriate?
Of course not. The history, symptoms and physical
exam suggest otherwise.
Thus, it is self-evident that binary considerations
cannot be applied with any real assurance of its
functional relevance to a system as complex as the
human body.
LABORATORY STUDIES
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Biological systems are complex, multi-tiered,
dynamic interrelated and integrated systems
Yeast Protein Interaction Network
Bader and Hogue (2002) Nature
Integrated, inter-related system
INTEGRATED SYSTEMS
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Objective quantitative data (laboratory values)
are required to assess the organism
However, one must be able to provide functional
descriptions of quantitative and qualitative
activity both within a particular unit of activity,
from one unit to another, as well as within the
system as a whole
Only then can a truly dynamic and individualized
assessment of the patient occur
LABORATORY STUDIES
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1)
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3)
The endocrine system, as the manager of the
metabolic activity of the body, is the ideal
object of evaluation.
Serum levels of hormones reflect neither the
degree of stimulation needed nor the
metabolic costs incurred in producing a
particular hormone.
Raison CL, Miller AH. When not enough is too much: the role of insufficient
glucocorticoid signaling in the pathophysiology of stress-related disorders. Am J
Psychiatry. Sep 2003;160(9):1554-1565
Chiam K, Tilley WD, Butler LM, Bianco-Miotto T. The dynamic and static
modification of the epigenome by hormones: A role in the developmental origin
of hormone related cancers. Biochem Biophys Acta. Apr 2009;1795(2):104-109.
Gerhard I, Waibel S, Daniel V, Runnebaum B. Impact of heavy metals on
hormonal and immunological factors in women with repeated miscarriages.
Hum Reprod Update. May-Jun 1998;4(3):301-309
.
LABORATORY STUDIES
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Serum levels of hormones only reflect quantitative
organ output, not functional activity, which can be
affected by:
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Hormone receptor binding (affected by over- or underexpression of other hormones)1
Intracellular messenger activity1
Epigenetic changes2
Heavy metal toxicity3, etc.
Raison CL, Miller AH. When not enough is too much: the role of insufficient
glucocorticoid signaling in the pathophysiology of stress-related disorders. Am
J Psychiatry. Sep 2003;160(9):1554-1565
Chiam K, Tilley WD, Butler LM, Bianco-Miotto T. The dynamic and static
modification of the epigenome by hormones: A role in the developmental origin
of hormone related cancers. Biochem Biophys Acta. Apr 2009;1795(2):104-109.
Gerhard I, Waibel S, Daniel V, Runnebaum B. Impact of heavy metals on
hormonal and immunological factors in women with repeated miscarriages.
Hum Reprod Update. May-Jun 1998;4(3):301-309
LABORATORY STUDIES
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The ideal system of measurement of biological
processes thus should examine the metabolic
products of hormonal management of cellular
activity
Thus, the ideal laboratory system must
Reflect the complex, integrated and dynamic nature
of biological systems
• Describe the functionality of the system in its
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Qualitative function
Quantitative function
Individual unit, relative to other units and as a whole
Assess the organism at the metabolic and interstitial
level
BIOLOGY OF FUNCTIONS
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The Biology of Functions (BoF) quantifies functional
abilities of the organism, before and after the effects of
adaptation to stressors. Because functionality is
dynamic, a dynamic, integrated and evolutionary
methodology must be used instead of static lab values
BoF is based on a number of specific indices defined by
mathematical relations between commonly used blood
analysis data
The algorithms that permit the calculation of these
indices are based on the physiological relations that
exist between the direct or indirect products of
hormonal activity: cells, hormones or enzymes
(eosinophils, TSH and LDH, for example).
BIOLOGY OF FUNCTIONS
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These relations allow one to visualize the
functioning of the organism at every level:
maintenance of homeostasis, adaptation, recovery
after aggression, immunity, etc.
Each function is quantified by an index, specified
by a level of activity. The index expresses the
actual activity of that function, both in and of
itself and in relation to the metabolic and tissue
needs of the organism.
The whole set of indices gives an evolutionary
assessment of an individual body’s functionality,
system by system, organ by organ.
BIOLOGY OF FUNCTIONS
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SUMMARY: Biology of Functions:
• Allows one to determine:
• Pathogenic tendencies of the organism
• The stage of development and the degree of
severity of a potential pathology (i.e. cancer,
cardiac disease, degenerative neurological
disease)
• Can be used as a tool to track
• the natural development of pathology
• To derive a rational therapeutic treatment
• To evaluate the efficacy of the treatment
over time
POLYCYSTIC OVARIAN
SYNDROME (PCOS)
An Endobiogenic
Approach
BEYOND BINARY RELATIONSHIPS
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PCOS is a good example of how allopathic
medicine is beginning to realize the importance of
the qualitative relationship of hormones rather
than quantitative ones in and of themselves. The
following ratios have been found to be helpful in
diagnosing PCOS:
Estradiol to Dihydro-testosterone ratio (Endocr Regul.
2008 Mar;42(1):13-6)
• Glucose to Insulin ratio <4.5 (Endocrinol Metab Clin
North Am. 1999 Jun; 28(2):397-408, vii.)
• LH to FSH ratio >3 (Endocrinol Metab Clin North Am.
1997 Dec; 26(4):893-912.)
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WHERE TO PROCEED?
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Despite a growing recognition that the binary nature of
laboratory evaluations in not sufficient to understand the
spectrum of disease expression, Allopathic medicine lacks an
integrated assessment of ontology, etiology and treatment of
physiological derangements
Case in point: Standard of care for PCOS is to treat each
endocrino-metabolic derangement separately from each
other without considering their inter-relationship
There is no explanation for why only 50% of PCOS patients
are obese or why serum hormone levels may be normal
despite physical exam findings suggesting otherwise, or why
polycystic ovaries are not a sine qua non of PCOS
REDUCTIONISTIC TREATMENT PLAN
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The allopathic treatment of PCOS consists of a
piecemeal approach to inhibiting individual
hormones with no concern for how it may affect
the global functioning of the organism in its
anabolic and catabolic activity
Hirsutism: spironolactone , oral contraceptives 1
• Menstrual irregularities: Oral contraceptives ,
metformin,pioglitazone, spironolactone
• Hyperglycemia, Hyperinsulinemia: Metformin;
pioglitazone
• Infertility: clomiphene, letrozol, metformin,
pioglitazone
1. Drug treatments for polycystic ovary syndrome.
Radosh L . American Family Physician, April 15, 2009
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ENDOBIOGENIC APPROACH
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The Endobiogenic approach considers the
ontological role of all these endocrino-metabolic
and tissular derangements as being linked to the
body’s management of a fundamental structural
or functional problem
Prolactin can be elevated during chronic stress
Hyperestrogenism is often an attempt to
overcome Prolactin’s suppression of LH secretion
of progesterone for ovulation
ENDOBIOGENIC APPROACH
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Hyperandrogenism: caused by DHEA from the adrenal gland,
which is over-stimulated due to the stress state, and by
testosterone from the ovaries due to LH excess, insulin excess,
and/or increased theca cell enzyme activity.1
Hypercholesterolemia with low HDL cholesterol: Cholesterol is
the source of all sex hormones and corticosteroids, which are
needed to make more and more testosterone, estrogen and
progesterone. HDL removes cholesterol from tissues which
would be counterproductive to the demand of the tissues for
more cholesterol.
Hyperglycemia and hyperinsulinism reflect an attempt to meet
the huge anabolic demands of the body with an appropriate
amount of short term energy substrate
1.
The biochemical basis for increased testosterone production in theca cells propagated from patients with polycystic ovary
syndrome
2.
Nelson VL, Qin KN, Rosenfield RL, Wood JR, Penning TM, Legro RS, Strauss JF 3rd, McAllister JM. J Clin Endocrinol Metab.
2001 Dec;86(12):5925-33.
BIOLOGY OF FUNCTIONS (BOF)
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Endobiogenic approach to PCOS involves
understanding the totality of endocrinologic,
neurologic and metabolic disturbances in relationship
to each other.
A few examples of the 157 indices of the biology of
functions are discussed as relevant to PCOS
When interpreting the BoF, the endocrine system is
understood in its
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classical vertical activity (i.e. CRHACTH Cortisol),
horizontal activity (i.e. Dopamine CRH TRH
Prolactin), and
radial activity (i.e. TRH Prolactin Insulin; Estrogen
+ Cortisol Luteinizing Hormone)
CATEGORIES OF BOF
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Hypothalamic and pituitary level assessment of
responsiveness to stimulation and feedback:
-MSH/α-MSH
• FSH #1 index
• LH #1 index
• Index of Estrogen-Somatotropic axis:
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BIOLOGY OF FUNCTIONS
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Role of Adrenals vs. Gonads in producing
androgens (Androgenic index)
Efficiency of FSH and LH in producing estrogens
and androgens, respectively (Gonadotropic
index)
Anabolic activity of estrogen (Quantative
organo-tissular estrogen yield index)
Progesterone activity (Progesterone index)
BIOLOGY OF FUNCTIONS
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The role of the Hypothalamic-Pituitary-Adrenal
axis can be examined in various ways to
understand the role of each endocrine gland in
adaptive and maladaptive responses to stress
Circulating Cortisol Index
• Aromatization of Estrogen Index
• Adrenal cortex index
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BIOLOGY OF FUNCTIONS
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Role of the Somatotropic axis in general
adaptation, maladaptation, and metabolic
derangements can also be examined:
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Prolactin index
Insulin index
Insulin resistance index
Growth Hormone (GH) growth score
Somatostatin index
BIOLOGY OF FUNCTIONS
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Psychological factors contributing to stress can
also be quantified
Global mental activity: Ketonic index
• Internal dialogue: Adaptogenic index
• Emotional etiology of stress response: Thyroid
relaunching index adjusted
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CLINICAL PHYTOTHERAPY
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Endobiogeny has developed a rational system of
clinical phytotherapy based on clinical studies,
empirical observations and traditional herbalism
Elevated Prolactin: Strawberry leaf (Fragaria
vesca) mother tincture reduces pituitary and
adrenal stress response through reduction of
ACTH, TSH and Prolactin and aromatization of
Adrenal androgens to estrogen
Elevated Androgens-Estrogen ratio: hops
(Humulus lupulus) has estrogenic activity and
inhibits LH, reducing total gonadal androgens1
1) Milligan SR, Kalita JC, Pocock V, et al. The endocrine activities of 8-prenylnaringenin
and related hop (Humulus lupulus L.) flavonoids. J Clin Endocrinol Metab. Dec
2000;85(12):4912-4915.
CLINICAL PHYTOTHERAPY
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Clinical phytotherapy (cont.)
Estrogen activity: Chaste tree (Vitex agnus castus)
is highly efficacious in its ability to alter receptor
sensitivity to estrogen and modulate prolactin activity
allowing for increased progesterone activity, restoring
prospects for fertility1,2
• Insulin Resistance: Wolfberry (Lycium barbarum)
as a fluid extract or bulk herb reduces insulin
resistance3
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1)
Liu J, Burdette JE, Sun Y, et al. Isolation of linoleic acid as an estrogenic compound
from the fruits of Vitex agnus-castus L. (chaste-berry). Phytomedicine. Jan
2004;11(1):18-23.;
2)
Loch EG, Selle H, Boblitz N. Treatment of premenstrual syndrome with a
phytopharmaceutical formulation containing Vitex agnus castus. J Womens Health
Gend Based Med. Apr 2000;9(3):315-320.
3)
Zhao R, Li Q, Xiao B. Effect of Lycium barbarum polysaccharide on the improvement
of insulin resistance in NIDDM rats. Yakugaku Zasshi. Dec 2005;125(12):981-988.
OTHER TREATMENTS
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Nutritional support
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Omegas 3 and 6 (cell wall stability, decreased
inflammation, improved gonadotropic activity1)
Magnesium and Calcium (noradrenaline, acetylcholine
production, activity and recycling)
B complex (management of stress)
Diet: low in inflammatory foods such as refined flours
and sugar to reduce insulin secretion and insulin
resistance, androgen activity2
Stress relief: cognitive behavioral therapy,
meditation, yoga, massage therapy, acupuncture
1) Sidani M, Campbell J. Gynecology: select topics. Prim Care. Jun
2002;29(2):297-321, vi; 2) Smith R, Mann N, Makelainen H, Roper J,
Braue A, Varigos G. A pilot study to determine the short-term effects of a
low glycemic load diet on hormonal markers of acne: a nonrandomized,
parallel, controlled feeding trial. Mol Nutr Food Res. Jun 2008;52(6):718726.
CONCLUSIONS
CONCLUSIONS
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Endobiogeny is the study of the internal milieu of the
organism within itself and in its relationship with its
environment, stressors, etc. from the standpoint of the
endocrine system as the manager of human life
It combines in an integrative understanding:
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a philosophical consideration of the ontology of structures
and functions of the body,
a rational approach to understanding physiology
an empirical assessment of history and symptoms
utilization of a dynamic, integrative and integrated
metabolic assessment of endocrine management of the
organism called the “Biology of Functions”
an integrated assessment of all clinical data to obtain a
precise understanding of maladaptive physiology
In order to create a rational, individualized treatment plan
CONCLUSIONS
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The Biology of Functions is an algorithmic
assessment of the qualitative and quantitative
relationships of hormones in terms of metabolic
activity from nuclear, cellular, tissue, organ and
system-wide perspectives
The Biology of Functions allows for an objective,
longitudinal assessment of the effects of therapy over
time
Endobiogeny relies on phytotherapy, oligotherapy,
and diet as well as lifestyle modification as its
preferred methods of ameliorating physiological
imbalances
It reserves the use of synthetic drugs for urgent cases,
or when the body is not able to establish an
equilibrium by the effects of functional regulation
RESOURCES
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To learn more about Endobiogeny:
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Web:
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Genearal information:
• www.endobiogeny.com
Biology of Functions demonstration:
• http://extranet.endobiogenics.com/en/
CONTACT
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Kamyar M. Hedayat, MD, President, American Society
for Endobiogenic Medicine and Integrative Physiology
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Contact: [email protected]
Web: www.endobiogeny.com