Integrative Medicine Immune Modulation through mind-body connection

1. Integrative Medicine Immune Modulation through mind-body connection John Kim, MD MPH Director Georgia Integrative Medicine www.georgiaintegrative.com

2. Vision “Imagine a world - oriented toward healing rather than disease, where physicians believed in the natural healing capacity of human beings, and emphasized prevention above treatment. In such a world, doctors and patients would be partners working toward the same ends.” • Andrew Weil, M.D.

3. Integrative Medicine • Integrative Medicine is healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. • It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.

4. Integrative Medicine • Taught in more than 20% of medical schools. • Percentage of individuals who have used CAM – now over 50%; in France over 70% used. • Recent estimates have more than 24 billion dollars spent out of pocket health care dollars • Total projected growth of CAM = 1 trillion dollars

5. University of Hawaii Thomas Jefferson University University of Maryland University of Massachusetts University of Michigan University of Minnesota University of Medicine and Dentistry of New Jersey U Penn University of Pittsburgh University of Texas Medical Branch University of Washington The Consortium of Academic Health Centers for Integrative Medicine • George Washington University • Oregon Health and Science University • University of Calgary • University of Arizona • UCLA • UCSF • Columbia University • Duke University • Albert Einstein College of Medicine • Georgetown University • Harvard University

6. Healing • Healing • To become whole and sound; return to health • To restore to health or soundness; cure. • To set right; repair: healed the rift between us. • To restore (a person) to spiritual wholeness.

7. Curing • Restoration of health; recovery from disease. • A method or course of medical treatment used to restore health. • An agent, such as a drug, that restores health; a remedy. • Something that corrects or relieves a harmful or disturbing situation: The cats proved to be a good cure for our mouse problem.

8. Simplicity and Complexity • Simplicity and Linear Progression • Science and Technology is based on Cartesian model of repeatability and predictability. • Complexity and Non-Linear Evolution • The idea of complexity is more accepted in business, science, and in medicine.

9. Tao • Translates to Road or Path or Way • Roads serve as an effective and efficient way for travel – roads exists even remote mountains created by animals’ frequent movements. • Efficiency – Reduces unnecessary expenditure (waste) of time, energy, and other resources. • Effective – Ensures achievement of desired outcome • Example: Asian Martial Arts • Minimum effort  Maximum result • Effective and Efficient

12. Simplicity and Complexity • Simplicity and Linear Progression • Science and Technology is based on Cartesian model of repeatability and predictability. • Complexity and Non-Linear Evolution • The idea of complexity is more accepted in business, science, and in medicine.

13. Linear Model of Development of History Geography determined destiny Guns, Germs, and Steel

15. Complex System and Network Theory • Linked – How Everything is Connected to Everything Else and What it Means for Business, Science, and Everyday life. Albert-László Barabási

16. Complex System • A complex system is a self-organizing collection of multiple parts that interact in interrelated, interdependent, and unpredictable ways.

17. Example in Family Therapy • One person may be the identified patient, the pathology may lies in the dynamics of the family as a whole system or network.

18. Example in Disease • Diseases are multifactorial. Genetics, lifestyle behaviors, depression, and poor social support could all contribute to the heart attack and no single factor accounts for the event. However, factors interact and act in a complex manner. • Cancer is an example of illness which often takes years to develop.

19. Example in Biology • A cell is a dynamic system or network that is part of a larger, more complex network that is a person. In turn, a person I s a dynamic network that is part of larger, more complex networks that constitute his or her social world or context.

20. Network Theory • Living networks manifest as small worlds tied together into modular, interactive networks by weak ties, weak links, or interactive relationships between clusters of more-strongly interconnected parts or nodes.

21. Linearity and Western Medicine • Most of Medicine today developed in response to challenged faced over a century ago. • Infectious Disease follow linear patterns and responds to linear interventions such as antibiotics • Chronic Disease which account for most of the problems in medicine follow complex pattern – i.e. Cancer

22. Tools for Healing • Paradigms or Filters • Energetics – Paradigm for Insight • Mindfulness • Intuition • Intention • Focus • Concentration

23. Modalities to Consider • Conventional Medicine • Pharmacology • Procedures • Mind-Body • Mindfulness Meditation • Hypnosis • Guided Imagery • Nutrition • Omega-3 fatty acid supplementation • Herbal COX-2 inhibitors • Reduction of Omega-6 fatty acid

24. Modalities to Consider • Herbs & Supplements • Nutrition & Physical Activity - TLC • Spiritual Medicine • Energy Medicine • Healing touch, Reiki, Jorei, Qi Gong • Integrative Physical Therapy • Therapeutic Yoga/Restorative Yoga • Feldenkrais, Alexander Technique • Bodywork • Massage, Shiatsu, Jinshin

25. Modalities to Consider • Manipulative Medicine • OMT, Chiropractic, Craniosacral therapy • Traditional Healing • Oriental Medicine • Naturopathy • Homeopathy • Ayurveda • Tibetan Medicine • Native American Healing • Find the best, the most affordable, the closest healer.

26. Integration Mastery Independence Interdependence Synergy

27. Miracles • Synergy in Complexity Science often can defy explanation in a linear world. • New principles in physics unlocked previously impossible amount of energy from small mass following Einstein’s famous formula E = mc 2

28. Bernie Siegel • Yale Surgeon who studied ECaP – Exceptional Cancer Patients in the 80’s • Love Medicine and Miracles • Support Group • Unconditional Love • Relationship Based Healing • Proactive Healing • PATIENT EMPOWERMENT • Learning from Inner-Self through Unconscious

29. Woman

30. Saxophone Player

31. See to Believe or Believe to See? • Expectation has an impact on outcome. • Perceived Norms • Non-Verbal Communication • Peer Pressure • Belief System • Unconscious Scripting

32. Believe to See • Biology of Disease • Natural History of Illness • Biology of Individual • Super-Normal

34. Psychoneuroimmunology • Psychoneuroimmunology (PNI) is the study of the interaction between psychological processes and the nervous and immune systems of the human body.

35. Psychoneuroimmunology • PNI takes an interdisciplinary approach, incorporating psychology, neuroscience, immunology, physiology, pharmacology, molecular biology, psychiatry, behavioral medicine, infectious diseases, endocrinology, and rheumatology.

36. History of PNI: Walter Cannon • Walter Cannon, a professor of physiology at Harvard University, investigated the mind-body connection. • In his work with animals Cannon observed that any change of emotional state in the animal, such as anxiety, distress, or rage, was accompanied by total cessation of movements of the stomach.

37. Walter Cannon • These studies into the relationship between the effects of emotions and perceptions on the autonomic nervous system, namely the sympathetic and parasympathetic responses that initiated the recognition of the freeze, fight or flight response.

38. Hans Seyle • Hans Selye experimented with animals putting them under different physical and mental adverse conditions and noted that under these conditions the body consistently adapted to heal and recover.

39. Hans Seyle • Several years of experimentation that formed the empiric foundation of Dr. Selye's concept of the General Adaptation Syndrome. • This syndrome consists of an enlargement of the adrenal gland, atrophy of the thymus, spleen and other lymphoid tissue, and gastric ulcerations.

40. Adler and Cohen • In 1975 Adler and Cohen demonstrated classic conditioning of immune function, and coined the term psychoneuroimmunology.

41. Adler • First Conditioned Saccharine-laced water and the drug Cytoxan which induces nausea, taste aversion, and suppression of the immune system. • After the initial conditioning, just feeding the rats saccharine-laced water was associated with the death of some animals • Adler proposed that rats had been immunosuppressed after receiving the conditioned stimulus.

42. Adler and Cohen • Ader (a psychologist) and Cohen (an immunologist) directly tested this hypothesis by deliberately immunizing conditioned and unconditioned animals, exposing these and other control groups to the conditioned taste stimulus, and then measuring the amount of antibody produced.

43. Adler and Cohen • Reproducible results demonstrated that conditioned rats exposed to the conditioned stimulus resulted in immunosuppression. • In other words, a signal via the nervous system (taste) modulated immune function. • First scientific experiments that demonstrated that the nervous system can affect the immune system.

44. Fenten • In 1981 David Felten discovered a network of nerves leading to blood vessels as well as cells of the immune system. • The researchers also found nerves in the thymus and spleen terminating near clusters of lymphocytes, macrophages and mast cells, all of which help control immune function. • This discovery provided one of the first indications of how neuro-immune interaction occurs.

45. Pert • In 1985, research by neuropharmacologist Candace Pert revealed that neuropeptide-specific receptors are present on the cell walls of both the brain and the immune system.

46. Pert • The discovery by Pert et al. that neuropeptides and neurotransmitters may act directly upon the immune system demonstrates a close association with emotions and suggests mechanisms through which emotions and immunology may be interdependent. • Showing that the immune and endocrine systems are modulated not only by the brain but also by the central nervous system itself has had an enormous impact on how we understand emotions, as well as disease.

47. Meta-analysesStress  Immune Function • In 1993, Herbert & Cohen examined 38 studies of stressful events and immune function in healthy adults. • Found consistent stress-related increases in numbers of total WBC, as well as decreases in the numbers of helper T cells, suppressor T cells, and cytotoxic T cells, B cells, and Natural killer cells (NK). • These effects were consistent for short-term and long-term naturalistic stressors.

48. Meta-analysesStress  Immune Function • In 2001, Zorilla et al. analyzed 75 studies of stressors and human immunity. • Naturalistic stressors were associated with increases in number of circulating neutrophils, decreases in number and percentages of total T cells and helper T cells, and decreases in percentages of Natural killer cell (NK) cells and cytotoxic T cell lymphocytes.