Functional Labs in Regenerative Medicine

Martin Gallagher, MD, DC, ABOIM

AAOM Annual Symposium

Clearwater, Florida

April 2018

Objectives

• Understand the role of Inflammation in disease

• Describe the triggers of inflammation• Learn chief characteristics of functional lab

medicine • Become aware of specific lab tests and how

they relate to the practice of interventional medicine

Laboratory Medicine Q&A

1. CRP is an important lab when assessing the role of inflammation? (True)

2. Digestive Stool Analysis can detect parasites and IBD markers? (True)

3. Chronic toxic metals are best tested with serum markers? (False)

4. Food allergies are a common cause of Migraine? (True)

What Causes PAIN?INFLAMMATION—the silent killer

Surprising link between

INFLAMMATION, PAIN, Diabetes,

Dementia, OA, Auto-Immune disease, Cancer

and Neurodegenerative diseases

Biomarkers of Inflammation

Biomarkers of Inflammation:

• LPS• CRP• IL-6, 10, 18• MCP-1 (monocyte chemoattractant protein-1)

• TNF alpha• Homocysteine• Insulin

• Appears to be a link between biomarkers, inflammation and disease.

Triggers of INFLAMMATION?

• American diet (SAD)• Nutritional Deficiencies• Trauma, mechanical stress, pain• Obesity, DM, CAD• Genetic factors and polymorphisms• Food allergies, toxins, heavy metals• Gut dysbiosis, SIBO, maldigestion/absorption• Fungal, Viral and Bacterial infections

TRIGGERS of INFLAMMATION?

• Prescription drugs, OTC’s, drugs/alcohol• Aging, hormone deficiencies• Lack of exercise and sleep• Toxic metals and chemical pollution• EMF toxicity• Loss of “the village”

CHRONIC INFLAMMATION & MEDICAL SPECIALTIES

• IROM: Tendinopathy, Ligamentosis, Fascial Tears

• ORTHO: OA, “itis”, trauma, tears

• Neurology: Dementia, AD, MS, Migraine

• Rheumatology: RA, Lupus, OA, CTD

• GI: IBS, IBD, GERD, Gastritis

• Derm: Eczema, Psoriasis, Fungal

• Cards: CAD, CHF, Hyperlipdemia

• Optho: MD, Cataracts, Uveitis,

• ENT: Rhinitis, sinusitis, Allergy, Tinnitus, Vertigo

• Pulmonary: Asthma, COPD, Bronchitis

• Family Medicine: Chronic pain, all of the above

What are Functional Medicine Labs

• Considers Impaired function vs Pathology• Assesses the functionality of the

Mitochondria, Digestive System, Nervous System, Reproductive System, etc.

• Consider loss of function in reference to Genetics and Epigenetics

• Analogy is Fasciae Tear/Enthesopathy/Subluxation vs. Muscle/Joint Pathology

ANTI-AGING LABS

• 24 hr Urinary Hormones; Salivary Cortisol/DHEA; Insulin

• Serum IGF-1, fT, TT, E2• CRP, Homocysteine, Lpa, Fibrinogen • Chem Panel• TSH, fT3, fT4

Anti-Aging Labs

• MTHFR• DNA Epigenetic Testing• Organic Acids• Food allergy• Stool Analysis • Toxic Metal Challenge• Vitamin/Mineral/EFA

MITOCHONDRIA/ATP

EPIGENETICS

MTHFR

• MTHFR is an enzyme that converts folate from your diet into an activated form of folate called 5-Methyltetrahydrofolate.

• When this happens your body is able to use this form of folate to produce hundreds of chemical reactions that are vitally important to having good health, some of these chemical reactions include:

MTHFR function

• The ability to produce essential neurotransmitters vital for good mental health

• The ability to make proper DNA, RNA & SAMe

• The ability to form red blood cells and white blood cells

MTHFR

MTHFR Functions

• The ability to make & use active folate

• The ability to use other vitamins, minerals, essential fatty acids and amino acids that work with folate

• The ability to recycle homocysteine to maintain proper Methylation

MHTFR Gene Types

• Heterozygous  = 1 copy of the gene from either parent

• Homozygous  = 1 copy of the gene from each parent

• Approximate percentages of reduced ability to produce MTHFR (methylene-tetrahydrofolate-reductase enzyme)

• MTHFR C677T Heterozygous = 40% loss of function

• MTHFR C677T Homozygous =  70% loss of function

• MTHFR A1298C Heterozygous = 20% loss of function (research not known)

• MTHFR A1298C Homozygous  = 40% loss of function

• MTHFR C677T & MTHFR A1298C heterozygous = compound heterozygous = 50% loss of function

Delayed Food Allergy Testing

• Assess over 200 foods, spices, herbs • Tests for IgE and IgG• Allergists test for IgE (immediate reactions)• Allergists test for 10 common foods and

airborne immediate reactions• IgG: tests for “delayed reactions”; up to 4

days

FOOD ALLERGY & INFLAMMATION

• 60 migraine sufferers who completed a 5-day period of withdrawal from their normal diet (subjects consumed lamb, pears and bottled water), the most common reactive foods were wheat in 78%, orange in 65%, eggs in 45%, tea and coffee in 40% each, chocolate and milk in 37% each, beef in 35% and corn, cane sugar and yeast in 33% each upon challenge.

• With the avoidance of 10 common foods, there was a dramatic reduction in the number of headaches per month, with 85% becoming headache-free.

• 25% of the subjects with hypertension became normotensive

• Food Allergies and Migraine, Lancet. 1979 May 5;1(8123):966-9.

Why Evaluate the MICROBIOME?

What is the Microbiome?

• Sum of all microbial organisms inhabiting the human body

• Includes bacteria, protozoa, fungi and viruses

• Majority live in the Gut (Colon> Small bowel)

MICROBIOME by the numbers

MICROBIOME

• The entire microbiome only weighs about 7.1 oz. with some weight estimates ranging as high as 3 pounds

• Some authors regard it as a "newly discovered organ" since its existence was not generally recognized until the late 1990s and it is understood to have potentially overwhelming impact on human health

BIOFILMS

• “Pond Scum”: 30 micron thick layer in GI tract• Protects intestinal lining• Metabolizes food remnants especially CHO• Communicates with the immune system• “Cross talks” between the gut epithelium and

the humoral and cell mediated portions of the mucosal immune system.

DIGESTIVE STOOL ANALYSIS

• Evaluate Gut-Brain-Pain Relationship• 3 consecutive Stools analyzed• Functional test of the Microbiome• Evaluates normal, imbalanced and dysbiotic

bacteria• Assesses fungal and parasitic components• Functional markers of Inflammation especially

IBD

DIGESTIVE STOOL ANALYSIS Indications

• GERD, Hiatal Hernia, Gastritis, Gastric Ulcers, Cholecystitis, IBS, IBD, Hpylori, Constipation, Diarrhea, Bloating

• Gut-Brain-Pain Relationship• FM, CFS, Chronic Allergies, MCS, Migraine,

Auto-Immune Disease

DIGESTIVE STOOL ANALYSIS

The Gut & Brain Speak

Gut/Brain NT’s

• 100 million neurotransmitters line the length of the gut, which is approximately the same number found in the spinal cord.

• Every single type of neurotransmitter that is found in the brain is also found in the gut.

• Serotonin in the gut plays an important role in intestinal motility, pain, memory, depression and anxiety.

• "Dr. Gershon Champions the Gut," Zoeller J, Medical Tribune, September 9, 1999;40(15):1,8.

Gut/Brain Connection

• Gut inflammation decreases thickness of the Biofilm (< 30 micron).

• Concomitant increase in intestinal permeability (Leaky Gut Syndrome)

• Auto-immune disease and non-AI disorders maybe linked to this phenomenon including Memory Decline

LEAKY GUT/LEAKY BRAIN

• Neurotoxic insult (heavy metals, inflammatory diet, nutritional deficiencies, viruses/fungus/bacteria, MSG, pesticides, herbicides, solvents, etc.) destabilize the “tight junctions” of the BBB.

• Result: “Neurogenic Inflammation”

• Parkinson’s disease, MS, Dementia, AD, ALS, Chronic Pain, behavioral and personality changes, Lyme disease

Neurogenic Inflammation

• CNS is “immunologically privileged”• Peripheral immune cells are normally blocked

by BBB• Neurogenic triggers compromise the

Microglia (resident innate immune cells)• Complication: Neurogenic Inflammation• Memory loss, Dementia, Alzheimer’s,

Migraine, Seizure, MS, PD, Cancer, etc.

TOXIC METAL CHALLENGE

• Step 1: Base line unchallenged 6hr Urine test for toxic metals.

• Step 2: IV Calcium/DiSodium EDTA and oral DMSA followed by 6hr Urine test

• Step 3: compare results and treat according to clinical findings and lab results

Scott Boice

• 48 yom with 2 yr history of parasthesias upper extremities

• Loss of grip strength (self employed contractor)

• Balance disorder (Frequent falls/tripping)• Progressive memory loss• Findings: pre-challenge negative, post-

challenge with EDTA and DMSA positive for Lead, Mercury and Gadolinium

Metal Test (pre-challenge): Scott Boice

Metal Test (post-challenge): Scott Boice

Scott Boice Rx

• 24 IV Chelation Treatments• 24 post Chelation Glutathione IV’s• Results: complete resolution of neurological

signs and symptoms• Receives “maintenance IV” monthly.

24 hr Urinary Hormones

• Assesses the free form of reproductive and adrenal hormones

• Compares hormones to age group vs age 35• Guides Prescription and type of Hormones

and/or Peptides to Rx (sc, po, IM)• Functional Goal setting: Females (no bleeding

and no breast tenderness); Males (no conversion to E2)

LYME & Co-Infections

• Lyme often coexists with candida, babesia, bartonella, ehrlichia and mycobacteria

• Consider other diseases: hypothyroidism, functional hypoadrenia, fungal infections, coinfections

• Treat the patient and not the lab

LYME Syndrome

LYME LABS & DX PITFALLS

• Because of the difficulty in culturing Borrelia bacteria in the laboratory, diagnosis of Lyme disease is typically based on the clinical exam findings and a history of exposure to endemic Lyme areas.

• The EM rash, which does not occur in all cases, is considered sufficient to establish a diagnosis of Lyme disease even when serologic blood tests are negative.•

Serological testing can be used to support a clinically suspected case, but is not diagnostic by itself

LYME & CDC

• “As with many infectious diseases, there is no test that can “prove” cure. Tests for Lyme disease detect antibodies produced by the human immune system to fight off the bacteria (Borrelia burgdorferi) that cause Lyme disease. These antibodies can persist long after the infection is gone. (Sep 5, 2017)

• Lyme Disease Frequently Asked Questions (FAQ) | Lyme Disease | CDC• https://www.cdc.gov/lyme/faq/index.html

LYME/Co-Infection Testing

• Igenex is most specific and sensitive at this point

• NY Criteria• CDC Criteria• CSF• Consider clinical findings vs. lab results• What to tell the patient?

Contact Information

Martin P. Gallagher, MD, DC, MS, ABOIMBoard Certified Family Medicine

Board Certified Integrative Medicine

Chiropractor

Physician Acupuncturist

Associate Professor, WVU Family Medicine

Medical Director

Medical Wellness Associates

6402 State Route 30

Jeannette, Pa. 15644

800-834-4325

gpmmwa@gmail.com

www.DrMartinGallagher.com

QUESTIONS