Integrative Medicine REYNALD ALTEMA, MD 37 th AMHE ANNUAL CONGRESS MONTEBELLO, QUEBEC

Integrative Medicine " Mind/body medicine is of course nothing new--What is new is the legitimization of research in this field to the point of government funding and the incorporation of mind/body programs into the offerings of major medical institutions, many of which are noted for their conservatism and scientific bent." William Collinge, MPH, PhD, Researcher. massgeneral.org/bhi BENSON-HENRI INSTITUTE AT HARVARD.

DISCIPLINES Homeopathy Naturopathy Ayurveda Traditional Chinese Medicine Massage Therapy Herbal Medicine Chiropractic Acupuncture rosenthal.hs.columbia.edu

Participating Institutions Mass Gen. massgeneral.org/bhi. University of Arizona University of Calgary Canadian Institute of Natural & Integrative Medicine University of California, Los Angeles Collaborative Centers for Integrative Medicine University of California, San Francisco Osher Center for Integrative Medicine Columbia University Richard and Hinda Rosenthal Center for Complementary & Alternative Medicine

Glucose Toxicity When there is too much glucose, 4 different pathways to circumvent glycolysis:  1-Hexosamine  2-Advanced glycation end products (AGE)  3-Diacylglycerol (DAG)-protein kinase C  Polyol Thiamine activates the Pentose pathway via Transketolase, removing Glyceraldehyde-3 phosphate and Fructose -6 phosphate. It prevents steps 1-3.

Advanced Glycation End Products (AGE) Formation of AGEs yields to free radicals such as Reactive Oxygen Species (ROS). Takes place via Receptor for AGEs(RAGE). AGES affect endothelial cells and monocytes. AGES cause irreversibe crosslinks with collagen, proteins and lipids. Presence of AGEs accelerates aging and causes cellular dysfunction.. Presence of AGEs increases microvascular as well as microvascular complications in Diabetes such as Retinopathy, Nephropathy... 1-Tan et al. 2-Balakumar et al. The multifaceted therapeutic potential of benfotiamine. Pharmacological Research. June 2010.

Benfotiamine Thiamine analogue Better absorbed than Thiamine. Gets converted to Thiamine Improves diabetic neuropathy Was developed in japan for treatment of alcoholic neuropathy. Ref: 1-Stracke H,. A benfotiamine-vitamin B combination in treatment of diabetic polyneuropathy. Exp Clin Endocrinol Diabetes 1996; 104(4): Tan et al, AGE, RAGE and ROS in Diabetic Nephropathy. Seminars in Nephrology. March

OMEGA-3 FATTY ACIDS EPA-Eicosapentaeinoic acid DHA-Docosahexaeinoic acid Dose for cardiovascular protection: 1.5 gm/day. for antiinflammatory action: 4-6 gms/day. Concentrated preparations: Krill oil-not to be used in case of shellfish allergy. Vectomega-very concentrated.

Omega-3 Fatty Acids 1-HTNGRADE A 2-HYPERTRIGLYCERIDEMIAGRADE A 3-SECONDARY PREVENTION OF CADGRADE A 4-PRIMARY CAD PREVENTIONGRADE B 5-RHEUMATOID ARTHRITISGRADE B 6-ANGINA PECTORISGRADE C A-nlm.nih.gov/medlineplus/druginfo/natural/patient B-Lee et al Mayo Clin Proc. March (3):

BROMELAIN Extract of pineapple. Proteolytic enzymes: papain, chymotrypsin, bromelain, phosphatases, glucosidases, etc. Properties: antiinflammatory, digestive enzymes, antiedematous. Uses: alongside antibiotic, other antiinflammatory meds. H. R. Maurer. Bromelain: biochemistry, pharmacology and medical use. Cell. Mol. Life Sci. 58 (2001) 1234–1245.

CoQ 10 & Cholesterol Synthesis

Oxydative Phosphorylation

Uses of Ubiquinone 1-Patients on statins. 2-Patients who have cardiovascular Comorbidities. It improves cellular function. 3-As antioxidant.