Web of DysfunctionWeb of DysfunctionKirti Kalidas M.D., N.D.Kirti Kalidas M.D., N.D.

Board Certified Internal MedicineBoard Certified Internal MedicineLicensed Naturopathic PhysicianLicensed Naturopathic Physician

Center for Natural and Integrative MedicineCenter for Natural and Integrative Medicine407 355 9246407 355 9246

www.drkalidas.comwww.drkalidas.com

Web of DysfunctionWeb of Dysfunction

BackgroundBackground• Medical school in South Africa, Residency and Medical school in South Africa, Residency and

private practiceprivate practice• Frustration and need for changeFrustration and need for change

NaturopathyNaturopathy• Basic principlesBasic principles• ModalitiesModalities

Balance of MD and NDBalance of MD and ND Web of DysfunctionWeb of Dysfunction

MD/ND PerspectiveMD/ND PerspectiveDevelopment of ParadigmDevelopment of Paradigm

Broad ranged , multiple modalities-How do you Broad ranged , multiple modalities-How do you apply yourselfapply yourself

Disease vs Wellness paradigmDisease vs Wellness paradigm Frustration of 2 years of practice: Acceptance, Frustration of 2 years of practice: Acceptance,

new patients problem resolution, percentage new patients problem resolution, percentage return visits, building inroads into the communityreturn visits, building inroads into the community

How quickly can I get to the root cause????How quickly can I get to the root cause???? Successful Practices: Focusing on one area, Successful Practices: Focusing on one area,

modality or true integration in broad range of modality or true integration in broad range of conditionsconditions

Liver, Pancreas, GB, Stomach

Detox Insulin resistance Impaired digestion

ISDISD

Chronic Infections : viral , bacterial, Fungal, Chronic Infections : viral , bacterial, Fungal, Parasitic, sites for occult low grade Parasitic, sites for occult low grade infections, Nanobacteria, Helicobacter, infections, Nanobacteria, Helicobacter, Chronic Lyme and co-infectionsChronic Lyme and co-infections

Auto immune conditionsAuto immune conditions Asthma, allergies, Chemical hypersensitivityAsthma, allergies, Chemical hypersensitivity Neurological: MS, tics, tremor, Chronic pain, Neurological: MS, tics, tremor, Chronic pain,

neuropathiesneuropathies

What is my Toxic burden?What is my Toxic burden?

Maternal/Transplacental transferMaternal/Transplacental transfer Immunizations/ thimerosal/flu shotsImmunizations/ thimerosal/flu shots Environmental: pesticides, solvent, heavy Environmental: pesticides, solvent, heavy

metals, occupational, Toys from China, metals, occupational, Toys from China, arsenic in playground equipment, air arsenic in playground equipment, air pollution etcpollution etc

Food and water sourcesFood and water sources Habits: smoking, alcohol, recreationalHabits: smoking, alcohol, recreational EMWaves etcEMWaves etc

The need for metabolic detoxification The need for metabolic detoxification is increasing dailyis increasing daily

EPA Study of toxins in human adipose tissueEPA Study of toxins in human adipose tissue11

• 100% of sampled contained plastics, solvents and 100% of sampled contained plastics, solvents and dioxinsdioxins22

• 83% also contained PCBs83% also contained PCBs

U.S. Pesticide use – 4 billion pounds annuallyU.S. Pesticide use – 4 billion pounds annually

• 8 pounds for every man, woman and child8 pounds for every man, woman and child33

• FDA Pesticide Residue MonitoringFDA Pesticide Residue Monitoring44

• Pesticide residue was found in 50.5% of domestic Pesticide residue was found in 50.5% of domestic fruits and 27.5% of domestic vegetablesfruits and 27.5% of domestic vegetables

1 EPA’s Office of Prevention, Pesticides and Toxic Substances 1999

2 US EPA National Adipose Tissue Survey 1982 4 Styrene, 1,4 Dichlorobenzen, xylene, ethylphenol, and TCDD

3 FDA Pesticide Program Residue Monitoring 2002 5 Body Burden, Environmental Working Group 2005

Over 167 synthetic chemicals and carcinogens are now found in the

average human body5

The need for metabolic detoxification The need for metabolic detoxification is increasing dailyis increasing daily

Over 167 synthetic chemicals and carcinogens Over 167 synthetic chemicals and carcinogens are now found in the average human body° are now found in the average human body°

EPA Study of toxins in human adipose tissueEPA Study of toxins in human adipose tissue۰۰• 100% of sampled contained plastics, 100% of sampled contained plastics,

solvents and dioxins** solvents and dioxins** • 83% also contained PCB’s83% also contained PCB’s• U.S. Pesticide useU.S. Pesticide use4 billion pounds annually 4 billion pounds annually

8 pounds for every man, woman and child8 pounds for every man, woman and child* *

۰ US EPA National Adipose Tissue Survey, 1982 * EPA’s Office of Prevention, Pesticides and Toxic Substances, 1999

° Body Burden, Environmental Working Group, 2005 **Styrene, 1,4 Dichlorobenzen, xylene, ethylphenol, and TCDD

Research shows that this level of exposure to environmental toxins may lead to significant

health challenges in your patients

J Clin Pharmacol 1997;37(7):635-48. Interpatient variability: genetic predisposition and other genetic factors.

West WL, Knight EM, Pradhan S, Hinds TS.

Center for Drug Abuse Research (CDAR), Howard University, Department of Pharmacology/Center for Drug Abuse Research, College of Medicine, Howard University, Washington, DC 20059, USA.

Polymorphisms and other genetic factors related to enzymes metabolizing drugs and xenobiotic chemicals are well known. This article focuses on selected molecular mechanisms and introduces some of the clinical implications arising from genetically determined interpatient variability or expression in some of these enzymes. Selected are the polymorphic enzymes of cytochromes P-450 (CYP) as examples of phase I enzymes and methyl transferases, n-acetyl transferases, and glutathione-s-transferases as examples of phase II enzymes. The polymorphism surrounding arylhydrocarbon hydroxylase induction is briefly described. Phase I enzymatic reactions are predominantly oxidative, whereas phase II reactions often couple with the byproducts of phase I. Overall, in poor metabolizers, whether phase I or phase II, there is limited metabolism in most patients unless another major metabolic pathway involving other enzymes exists.

Research identifies significant genetic variation in CYP450 Phase I enzyme expression in humans. These variations have a significant impact on the patients ability to clear toxins.

Even genetic factors may be contributing Even genetic factors may be contributing

to your patients ability to clear toxinsto your patients ability to clear toxins

Candida and DysbiosisCandida and Dysbiosis

Traditional MD thinking and trainingTraditional MD thinking and training Candida – invasive vs overgrowthCandida – invasive vs overgrowth GI balance and wellnessGI balance and wellness Antibiotics in foodsAntibiotics in foods Probiotics in FoodsProbiotics in Foods

Permeability, Food Sensitivity, Permeability, Food Sensitivity, Nutritional deficiencyNutritional deficiency

What is the true What is the true nutritional status of nutritional status of our patientsour patients

Is my bag of pills Is my bag of pills working for meworking for me

Type of dietType of diet Empiric treatment Empiric treatment

until results available-until results available-Key nutrient support Key nutrient support and possible IV and possible IV supportsupport

CNS and HP DysfunctionCNS and HP Dysfunction

History of trauma, abuse, stressors-History of trauma, abuse, stressors-move, job, financial, student loans, move, job, financial, student loans, marital, relationship, toxic exposuremarital, relationship, toxic exposure

The switch/fuse box- Fatigue to The switch/fuse box- Fatigue to Fantastic Dr Teitalbaum---THINS—Fantastic Dr Teitalbaum---THINS—Toxic, Hormonal, Infectious, Toxic, Hormonal, Infectious, Nutritional, Sleep Nutritional, Sleep

Hormonal ImbalanceHormonal Imbalance Thyroid vs. adrenal or combined Thyroid vs. adrenal or combined

symptomssymptoms Classic signs and symptoms of Classic signs and symptoms of

hypothyroidismhypothyroidism Functional hypothyroidism and testingFunctional hypothyroidism and testing Show severity of adrenal imbalance Show severity of adrenal imbalance

fatigue /burnoutfatigue /burnout Low dose thyroid supportLow dose thyroid support Use of bio identical hormones in womenUse of bio identical hormones in women Testosterone use in clinical practiceTestosterone use in clinical practice Melatonin, growth hormone etcMelatonin, growth hormone etc

Test used in my practiceTest used in my practice

Basic core labsBasic core labs• Additional blood test, Additional blood test,

Cardiac, Rheum, Cardiac, Rheum, LymeLyme

Salivary hormonesSalivary hormones Heavy metal testingHeavy metal testing SpectracellSpectracell Food sensitivitiesFood sensitivities CSA with parasitesCSA with parasites Organic Acid testingOrganic Acid testing

NeuroscienceNeuroscience Gluten /casein peptideGluten /casein peptide Metallotheinin/Zn and Metallotheinin/Zn and

coppercopper US, CT, MRI etcUS, CT, MRI etc FFA analysis, hepatic FFA analysis, hepatic

detox pathwaydetox pathway Condition specific test Condition specific test

Case Study 1Case Study 1

42 year dental professional with 42 year dental professional with chronic GI symptoms, chronic chronic GI symptoms, chronic palpitations, resting heart rate of palpitations, resting heart rate of 100-110 bpm, failed medical and 3 100-110 bpm, failed medical and 3 ablation attemptsablation attempts

Test orderedTest ordered

Treatment and resolution of symptoms Treatment and resolution of symptoms in 3 monthsin 3 months

Case 2 Case 2

38 yr female background history 38 yr female background history myalgia, 2 auto accidents, myalgia, 2 auto accidents, exacerbation of RSD symptoms for 8 exacerbation of RSD symptoms for 8 years. TMJ surgery x2. Chronic pain years. TMJ surgery x2. Chronic pain and spasm requiring massage and spasm requiring massage therapy twice weekly with minimal therapy twice weekly with minimal improvementimprovement

TestTest TreatmentTreatment

Case 3Case 3

51 yr old female , failed 22 MD 51 yr old female , failed 22 MD treatment over 3 years for chronic treatment over 3 years for chronic leg pain, sensitivity, leg pain, sensitivity, hyperparasthesia, fatigue, hyperparasthesia, fatigue, perimenopausal symptoms and perimenopausal symptoms and chronic constipation.chronic constipation.

Impression and testImpression and test Course of treatmentCourse of treatment

Case 4 Case 4

39 yr female with chronic fatigue, 39 yr female with chronic fatigue, weight gain, hypothyroidism, 7years of weight gain, hypothyroidism, 7years of stress with son with sensory stress with son with sensory integrative issuesintegrative issues

Not much hope given by Not much hope given by endocrinologistendocrinologist

Physical evaluationPhysical evaluation TestTest outcomeoutcome

Case 5Case 5

42 yr disabled wheelchair bound, 3 42 yr disabled wheelchair bound, 3 failed back surgeries, chronic failed back surgeries, chronic persistent leg pain, Reactive airways persistent leg pain, Reactive airways Disease on Oxygen, chronic foley Disease on Oxygen, chronic foley catheter use and scheduled bladder catheter use and scheduled bladder surgerysurgery

TestsTests Treatment and outcomeTreatment and outcome

Case 6Case 6

4 year old Asian male , nonverbal , 4 year old Asian male , nonverbal , gross motor normal, poor fine motor gross motor normal, poor fine motor skills , advised by pediatric skills , advised by pediatric neurologist to continue monitoring neurologist to continue monitoring and bring him back if he has and bring him back if he has seizuresseizures

TestTest TreatmentTreatment

Case 7Case 7

54 yr old with RA and weight gain 54 yr old with RA and weight gain and stress post hurricane in 2005and stress post hurricane in 2005

PhysicalPhysical TestTest OutcomeOutcome

Case 8Case 8

45 year old school teacher with 45 year old school teacher with Fatigue, Asthma, Anemia, fibroids, Fatigue, Asthma, Anemia, fibroids, recurrent URI and bronchitis and recurrent URI and bronchitis and Family history of ovarian cancerFamily history of ovarian cancer

Test Test treatmenttreatment

Case 9Case 9

46 yr old female with CFS for 10 46 yr old female with CFS for 10 years, fibromyalgia, joint pain and years, fibromyalgia, joint pain and severe “brain fog”. Seen by multiple severe “brain fog”. Seen by multiple physicians and alternative doctorsphysicians and alternative doctors

Evaluation and test Evaluation and test Treatment and outcome Treatment and outcome

Case 10Case 10

8 yr old WM with 3 year history of 8 yr old WM with 3 year history of abdominal pain , full GI workup, abdominal pain , full GI workup, learning disorderlearning disorder

Test Test Treatment Treatment Outcome in 3-4 monthsOutcome in 3-4 months

Take HomeTake Home Our health is a product of gene expression, toxic Our health is a product of gene expression, toxic

exposure, functional and hormonal imbalances exposure, functional and hormonal imbalances and lifestyle choicesand lifestyle choices

Integration of modalitiesIntegration of modalities Working with MD’s and other health care Working with MD’s and other health care

providersproviders Stepwise testing and support and addressing Stepwise testing and support and addressing

each area each area Optimizing health, hope and healing by Optimizing health, hope and healing by

addressing the root causeaddressing the root cause