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From the Townsend Letter
July 2019

International College of Integrative Medicine (ICIM) Meeting – A Message from Your Heart
by John Parks Trowbridge, MD, FACAM
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ICIMRecognizing the accelerating pace of new scientific understandings for cardiovascular disease and its sequelae, the International College of Integrative Medicine (ICIM) hosted a five-day meeting in March 2019, in Philadelphia, Pennsylvania, to introduce advanced treatment approaches that can be employed in the office "on Monday morning." In acknowledgment of the multifactoral elements of degenerative diseases, program chair Eric Born, DO, of Grand Rapids, Michigan, created a general sessions program spanning all interests. Inflammation took center stage.
Studies continue to show the impact that frustration and stress have on contributing to heart diseases, said James Greenblatt, MD, of Waltham, Massachusetts. Strikingly he offered that many of those suffering with mental illness will die 25 years earlier…from cardiovascular disease. Treatments for inflammation are critical for stress, depression, and suicide risk, to reverse cytokine interruption of neurotransmitters. Lowest blood total cholesterol levels have been shown, by meta-analysis, to be associated with higher suicide rate, similarly for higher iron levels. A biological model shows specific nutritional interventions that can address a model of prevention for the broken heart syndrome.
Looking beyond reduction of toxic metals through IV treatments, Anita Baxas, MD, of Miami, Florida, presented personal and scientific history and present use of IV phosphatidyl choline (Plaquex) for resolution of occlusive vascular changes. While treatment has been offered in Europe for many years, adoption in the United States has been slow. Plaquex alone or alternating with chelation treatments has shown reduction in occlusive plaque burden over several weeks; persistence of the effect has been questioned but reduction in clinical symptoms has been promising.

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Robert Rowan, MD
Robert Rowen, MD, explains latest protocol advances for ozone therapies.
Increasing evidence for the role that marginal thiamine (Vitamin B1) deficiency plays in general health and specifically in cardiovascular impairment (and prevention) was reviewed by Helen Kwon, MD, of Westlake, Ohio. Key to understanding the pathophysiology is relative (or actual) cofactor shortage creating a pseudo-hypoxia state with reduction of ATP-production efficiency in mitochondria in all cells, especially prevalent in nerve, heart, and brain tissues.

Advances in using ozone to reduce cardiovascular disease effects were reviewed by Robert Rowen, MD, internationally known for research, clinical practice, and teaching medical oxidation therapies, especially ozone. Foreign research continues and American research is now confirming the powerful antioxidant/anti-inflammatory changes induced by ozone administration via various routes, improving all organ functions affected by different pathologies.
Speaking from his vast experience and continuing laboratory and clinical research, Russell Jaffe, MD, PhD, of Ashburn, Virginia, shared a deeper understanding of relevant predictive biomarkers for cardiovascular and other degenerative diseases, in order to create and monitor disease-reversing then health-enhancing programs. Key data to assess functional age are hemoglobin A1c, hsCRP, homocysteine, hsLRA Lymphocyte Response Assay, first AM urinary pH, vitamin D, omega-3 index, and 8-OH-guanine. Epigenetic lifestyle choices (especially diet and supplements) have significant impact on these biomarkers and future survival by correcting inflammation pathology and resolving repair deficit.
NDNR Carotid intima-media thickness (CIMT) screening has the potential for early diagnosis and continuing management of diseases of heart and arteries, according to data presented by integrative cardiologist Alicia Williams, DO, of East Lansing, Michigan. Inflammation and oxidative stress markers, especially blood sugar, blood insulin, and abnormal lipids, are usually elevated in patients with thickened carotid intimal medial thickening, consistent with increasing cardiovascular risk. CIMT relates to carotid risk while stress echocardiogram can correlate evolving cardiac risk (related to soft plaque), even before calcium score elevation can be demonstrated.
World renowned Florida integrative cardiologist Thomas E. Levy, MD, presented the latest studies relating calcium and dental diseases to cardiovascular (and other degenerative) diseases. The pathophysiology of all such diseases is inflammatory, and studies of interaction with vitamin C is confirmatory, suggesting that most problems are "relative scurvy" of those tissues. For example, osteoporosis treatment requires stimulation of collagen production and interlinking, dependent upon osteoblastic precursor cells and then osteoblastic conversion – all stimulated by vitamin C. One hundred percent of degenerative diseases involve increased oxidative stress, leading to elevated intracellular calcium levels. Decalcification of these injured cells can help restore better health. Metastatic cancer is a classic model as well, where higher levels of intracellular calcium are found – along with neurodegenerative diseases. Long-acting calcium channel blockers decrease the chances of death from all causes; magnesium is nature's antagonist, lowering intracellular calcium and pulling in vitamin C. Women with highest bone density have the highest incidence of breast cancer. Higher coronary calcium score on the CT scan is correlated with higher death from all causes. Iron is pro-inflammatory as well, and ferritin should be below 20 ng/mL so long as no microcytic anemia observed.
Reduction of elevated homocysteine, as presented by Su Fairchild, MD, of Bloomsberg, Pennsylvania, shows considerable benefit in proper management of tissue inflammation. The methylation cycle and dependent production of nitric oxide are required for optimal health, especially of endothelial cells. Elevated cholesterol with all its sequelae (including coronary artery disease risk) can result from high homocysteine levels, while low levels appear to be related to peripheral neuropathy. Phosphatidyl choline supplementation helps ameliorate methylation impairment.

Gervasio Lamas, MD
Columbia professor of cardiology, Gervasio Lamas, MD, presents NIH TACT 1 data on reduction of coronary events with chelation protocol.
Stunning reductions in cardiovascular events due to reductions in body burden of toxic metals (lead and cadmium) has led the National Institutes of Health to the funding and initiation of the TACT 2 (Trial to Assess Chelation Therapy 2) to study more closely the amplified effects in diabetics. Miami, Florida cardiologist and Columbia professor of cardiology, Gervasio Lamas, MD, again is principal investigator. He notes that further mining of the TACT 1 data is revealing that environmental toxic exposure appears to be an independent and successfully modifiable risk factor for heart disease, certainly for those who have already suffered an infarction.
Cardiologist Thomas Levy, MD, presented the increasingly persuasive evidence for oral infections as a (the?) primary contributor to promotion and exacerbation of cardiac (and other degenerative) diseases. Exposure to mercury-amalgam fillings, root canals, periodontitis, persistent tonsillitis – indeed, chronic oropharyngeal and other infections of any kind – must be addressed in any comprehensive approach to virtually any lingering illness. Increased oxidative stress caused by pathogen-related toxins (and by compromised metabolic pathways) is a common denominator, so treatment requires repair of biomolecules that have been damaged and malfunctioning, creating the various disease findings. Likely the primary function of the immune system is to deliver vitamin C to areas under oxidative attack. Coronary (and cerebral) artery occlusive disease is a chronic acute response to persistent seeding/colonization of infection into the endothelium.
DesBioPatrick Theut, of Manistique, Michigan, offered data suggesting that suboptimal levels of vitamin K2 are a sadly unrecognized risk factor for cardiovascular and bone health – as well as all other organ systems. Data suggest that insufficient MK-7 resident on or in LDL, HDL, or VLDL contribute to heart disease, interacting with a number or physiologic abnormalities (low thyroid, low magnesium, APO-E status, fat soluble vitamins, several others). Vitamin K2 deficiency has emerged as an unrecognized contributor to degenerative diseases through carboxylation impairment, and reversal of occlusive changes is possible.
Integrative cardiologist, James Roberts, MD, of Toledo, Ohio, presented a delightful correlation he terms "CardioRheumatology," carefully tying together the pro-inflammatory links that disorder immune system responses in seemingly disparate organ systems – all relating to ongoing (even accelerating) degenerative changes. Oxidative stress, the kindling in the bonfire of degenerative disease (including arteritis), can be related to an induced pseudo-infection response in the absence of demonstrable infection. Minimal-dose colchicine added to conventional care lowered hsCRP and risk calculation over three years, specifically for acute coronary syndrome. By a similar mechanism, allopurinol appears to have significant benefits in many degenerative diseases, especially when avoiding high fructose corn syrup to reduce the chemical challenges needing reversal.
Increasing understanding of the contributions made by the APO-E gene diet to better cardiovascular health was shared by Pamela McDonald, FNP, of Danville, California, showing societal patterns associated with promoting inflammation. Changes in farm/food reporting have resulted in inflated calorie statistics for companies to show greater profits, and drugs administered to cows to increase milk production have led to pathophysiology creating increases in breast cancer and other degenerative diseases. APO-E typing allows selection of proper dietary intake to "fuel the engine" with regard to fat and sugar management. APO-E 4's who get diabetes get Alzheimer's dementia, and their treatment has to be carefully managed for reversal. Similar resolution of peripheral ulcers can be obtained as well. APO-E 2/3, 3/3, or 3/4 must be monitored for adequate and proper food choices, especially aimed to reduce body fat and increase lean mass (BMI). In many respects, the APO-E molecule appears to fats what insulin is to sugars.
Ready availability of the ultrafast CT scan has given increasing data regarding coronary calcium score progression, as offered by Jeff Dach, MD, of Davie, Florida, in the midst of a paradigm shift in cardiology. Inflammation, particularly associated with infections, has been directly implicated in calcification changes in all tissues, including coronaries, signaling the demand for a changing paradigm in severe disease development and treatment. EDTA chelation therapy was first shown in 1992 to reduce calcium scores in selected patients.
Surprising perspectives on metabolic endotoxemia were presented by Joel Kahn, MD, of Detroit, Michigan, where dietary changes are critical to address this "primary insult" that activates the gut-induced inflammatory state. Omega-3 fatty acids can be most protective, particularly against saturated fat intake associated with toxic LPS (microbial lipopolysaccharides). Studies need to be done to understand benefits and risks specifically for MCT (medium chain triglycerides), cream, and coconut oil. Causal relationships between fat-associated endotoxins and obesity, metabolic syndrome, and diabetes remain to be elucidated. Spore-based probiotic supplementation reduces post-prandial dietary endotoxin and triglycerides in response to high-fat meal challenge. Trimethylamine oxide (TMAO) is a gut-derived metabolite associated with dietary nutrients from fatty-loaded meats. Dietary choline accelerates atherosclerotic deposition, inhibited by antibiotics, suggesting microbial production of TMAO. Elevated TMAO not only can blunt HDL-removal of occlusive fatty changes but also promote macrophage uptake and occlusive deposition of lipids. The Mediterranean diet is a low-TMAO program for a variety of reasons. The abundance of carnitine in "energy drinks," especially when combined with choline, is of concern for development of unexpected platelet aggregation and thrombosis. Fasting-mimicking diet modulates microbiota and promotes intestinal regeneration to reduce inflammatory bowel markers.
TransferFactorBarrie Tan, PhD, of Hadley, Massachusetts, explained the cardiometabolic benefits of vitamin E tocotrienols, noting aside that studies are underway on other pathologies (obesity, cancer, fertility, neurodegenerative diseases). The "trienols" have taken a backseat to alpha-tocopherol, the marketed vitamin E discovered 100 years ago to help bring a fetus to term. Dietary intake is markedly deficient in meeting basic body need of about 250 mg daily. Ninety percent of antioxidants in cell membrane phospholipids are tocopherol – the remaining are mostly tocotrienols. Alpha-tocopherol-free supplementation is important to avoid antagonism and a reduced tocotrienol effect against inflammatory molecules, which interfere with protective benefit and tissue recovery from arteriosclerotic oxidative stress. Dr. Tan related that a hallmark observation from Stanford professor Gerald Reaven, MD, discoverer of metabolic syndrome: "Hypertriglyceridemia will always precede hyperglycemia," suggesting early supplementation might reduce emergence of pathology. Obesity and non-alcoholic liver steatosis result from disordered glucose/lipid metabolism. Tocotrienols have helped to reverse the associated inflammation and early fibrosis along with sponsoring weight loss. Infection (hepatitis C) and malignancy (liver and pancreatic cancer) appear to be advanced changes from metabolic syndrome.

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