IntegrativeMedicine GeneticsandLifestyleforCognitive

HealthInstituteforIntegralHealth,LLC

MaryAnnOsborne,DNP,FNP

Objectives● DiscusstheAPOEGeneandit’slinktochronicdisease● Demonstrateknowledgeoflifestyleandbrainhealth● IdentifythesubtypesofAlzheimer’sDisease● DiscussissueswithcaregiversofAlzheimer’sclients

MyJourney● Near-Deathexperienceatage7● HolisticBSNprogram● JoinedArmyNurseCorps● ArmyNursePractitioner–1986(AdultNP)●Master’swithcommunityfocus–1991(FNP)● IntegrativeMedicineFellow–2003● DoctorofNursePractice–2010● IndependentPractice-2005

TippingPoint

Personal&FamilyCrisis

PrograminIntegrativeMedicine● UniversityofArizonaSchoolofMedicine● 1994IMFellowship–Residential● 2000ResidentialandHybridDistance● 20031stNursePractitionergraduated● AnnualNutritionandHealthConference● Onlineprograms,IntegrativeHealthLifestyleprogram(IHeLp),IntegrativeHealthCoaching

● FreeEnvironmentalHealthcourse● Integrativemedicine.az.edu

IntegrativeMedicine● InaNutshell:

●Allowingtimeandspacetounderstandthepatient’sstoryandfosteradeeperunderstandingandconnectionwithourpatients.

TheMindfulTherapist

●Mostimportantthingyoucandoforaclientisto● BePresent.

● Shapiro,S.L.,&Carlson,L.E.(2009).Theartandscienceofmindfulness:Integratingmindfulnessintopsychologyandthehelpingprofessions.Washington,DC,US:AmericanPsychologicalAssociation.

DiscoveredtheApoEGeneGeneticsversusEpigeneticsSGeneticsolutionforTurningOffDisease

Genetics● Geneticcodecompletedin2003● Genetictestingismoreaffordablethanever● GeneticandEpigeneticresearchshowinglinkbetweenlifestyleanddisease.

● Lawprotectingourgenetics

Epigenetics● Physically:EpireferstothesheathofproteinsandchemicalsthatcushionandmodifyeachstrandofDNA.

●Malleableandfluid● EntireamountofepigeneticmodificationoftheDNAinyourbodyiscalledtheepigenome

● Exciting!It’sHereGenesgetturned“onoroff”●WecancontroltheswitchwithBalanceofMindBodySpirit

GeneofDiscussionApoEGeneProvidesatransportsysteminthehumanbody-mainlyforfatandcholesterol

APOEGene● ThoughttobeMainGeneofBodyDiscoveredin1973byLawrenceBerkeleyNationalLab

ResearchedattheGladstoneInstituteUCSF-SanFrancisco.

Discoveredfirstfor:Type111hyperlipidemiaAPOE2/2

APOEGeneandAlzheimer’s1992-1995AllenD.Roses,MD&hiscolleaguesconnectedtheApoEGenetoAlzheimer’sDiseaseatDukeUniversity

Alsoconnectedtodietarychangesandrecommendations

Onedietdoesnotfitall

CardiovascularDiseaseandAlzheimer’sCommonLink

●Alzheimer'sandCardiovasculardiseasearebothinflammatorydiseasesconnectedbythesamemarkers●InitialresearchwasCardiovascularhowevervasculardiseaseisalinktoAlzheimer’s

ArteryPenetrationofLDL

HeartDiseaseProgression

Alzheimer’s●SimilarProcesstoCVD?●ChronicIllnessindicatesinflammationandimbalance

CognitiveDecline● 5.8millionAmericanpatients● 5.6million>65● 200,000<65(althoughdifficulttogetestimate)● 487,000willdevelopin2019● Almost2/3ofAmericanswithAlzheimer’sarewomen● 115millionAmericanby2050atacostof$1.1Trillion

● 3rdleadingcauseofdeathintheU.S.(James,B.D.etal.ContributionofAlzheimerdiseasetomortalityintheUnitedStates.Neurology82,1045-1050,doi:10.1212/WNL.0240(2014)

CostofAlzheimer’sSignificantcostrelatedtoAlzheimer'sestimated$290billionin2019(healthcare,longtermcareandhospice)

67%ispaidbyMedicareandMedicaidOutofPocketspendingisestimated$63billion

43%ofcareisfromunpaidcaregiver’s18.5BillionHoursvaluedat$233.9Billion

AFemaleEpidemic● 2/3arewomen● 3.5millionarewomen/2.1millionaremen

● 2/3Caregiversarewomen● >1/3Caregiversaredaughters

●MorecommonthanbreastcancerintheU.S.

TypesofAD● Type1:Inflammation;APOE4gene

● 1.5Glycotoxic:insulinresistance,APOE4● Type2:Non-Inflammatory/Atrophic;APOE4;metabolicabnormalities;lossofhormones,vitamindeficiencies

● Type3:Toxic;APOE4negative(usually);<65onset;mostdifficulttotreat;causeisinfection,traumaorLeweyBody

TypesofAD● Type4:Vascular

● Lp(a)moleculeandlipids● Lipid.orgscientificstatement2019

● Type5:Traumatic

AD● Verycommontohaveacombinationoftypes● Forexampleglycotoxic(type1.5),inwhichtheadvancedglycationendproducts(AGEs)causeinflammationandtheinsulinresistanceleadstotrophicwithdrawalsignaling

● Otherinputssuchassleepapnea,trauma,andtoxinstriggeramyloidandtautanglesviathesesame3majorcauses(Inflammation/Atrophic/Vascular).

ConventionalAttitude “Thereisnothingthatwillprevent,reverse,orslowtheprogressofAlzheimer’sdisease.”

BredesenAttitude

SomedaysooneveryonewillknowanAlzheimer’ssurvivor

Neurologist’sSheraziandPerfectGeneDiet90%ofAlzheimer’scanbepreventedwithlifestyle

BredesenProtocol● DrDaleBredesen● BuckInstituteforResearchonAging,Novato,CA● Failureofmonotherapies●Multiplepathogenictargetsforpotentialdrugs● Chronicillnesssignalsimbalance/inflammation● FocusisReversalofAD● SimilartoaRoofwith36Holes

BredesenProtocol● “Alzheimer’sdisease”isapathologist’sdiagnosis.Thistermshouldnotbefollowedbyaperiodanymorethanfevershouldbe—Alzheimer’sdiseaseduetowhat?

●Whatisreferredtoas“Alzheimer’sdisease”isactuallyaprotectiveresponseto3majormetabolicandtoxicinsults:inflammation/infection,trophicwithdrawal,andtoxinexposure

BredesenProtocol●MappedthemanymolecularmechanismsofcognitivedeclineandADintoatreatmentprotocol.

● Includesdozensofinterventions,beginningwithDESS(Diet,Exercise,Sleep,StressReduction),hormonaloptimization,nutrients,targetedherbs,brainstimulation,drugs,etc.

● Nooneinterventionclosesall36holes● Approach:pulloutallofthestops

BredesenProtocol● Inflammation:resolution(resolvins),inhibition,removalofsource(s).

● Infections(chronic):Borrelia,othertick-borne,chronicviruses,etc..

● Atrophic:optimizationofhormones,homocysteine,methylation,trophicsupport,antioxidants,etal.

● Toxins:metalsincludingCu:Znratio,Hg;mycotoxins.●Metabolismincludingglycotoxicity(type1.5).● Regeneration,protection.

BasicConcepts● Identifyallcontributorstotheimbalancedplasticitynetwork

● Determinethedegreeofcontributiontoeachtype● Optimizethevalueofeachabnormality● Addressasmanyoftheabnormalitiesaspossible,theearlierintheprocessthebetterchanceforsuccess

● Designthetreatmenttobeasphysiologicalandupstreamaspossible

● Personalize

RiskFactors● Sleepapnea● Historyofheadtrauma● Historyoflossofconsciousness● Presenceofdentalamalgams● Historyofhypertension● Consumptionofseedoils● Neuroactivemedications(especiallywithanticholinergicactivity),directorindirect:e.g.,benzodiazepines,statins,protonpumpinhibitors,antipsychotics,antihistamines,anesthetics,ETOH,illicitdrugs,etc.

67y.o.womanwith2-yrhistoryofprogressivecognitivedecline●Motherdiedwithdementia,onsetage62.● Unabletonavigateonfreeway.● Couldnotrememberwhatshehadread.● Unabletopreparereportsforwork.● Unabletorecalleven4-digitnumbers.● Retinalscanpositiveforamyloid● TreatedwithMEND(metabolicenhancementforneurodegeneration).

Case1D.D.● 44yofemale,counselor,c/oforgetfulness,unabletofindwordsandforgettingclientsnames.“Feelsitisprogressing”

● Feelsshe’saddictedtosugar● Parentsarevisiting:MotherhasaveryhealthylifestyleandFatherisa“junkeater”;neitherhavememorychange

● Statesthatwhentheyarevisitingthisisabarriertoherchangingherlifestyle.

● Mostlysedentarywithoccasionalhike

Case1D.D.● ApoEGenetestresults:¾● Recommendeddietarychanges:initiallyavoiddairyandredmeat.Eatgoodfatssuchasavocado,oliveoil;basicallygaveherbabystepsduetoherresistance

● Dailyexercise:75%aerobic(sweatingisherfriend)● Reviewedhistory:lowriskinfectionorheavymetaltoxicity.Probableleakygut

● Elevatedglucose(98);TSH3.35● BeganNatureThroid;Berberinesupplement;initiallyMCToilandincreaseingoodfats

Case1D.D.● InitiallyDDresistedchangefor6months● Hadshifttobegincaringforherselfandbegandietarychanges;dailywalking;fasting3hoursbeforebedtime;begantotal12hourfast

●Within8weeksLost17pounds;memoryissuesresolved

● Greatexampleofearlieryoutreatthebetter!

Case1D.D.● Shefelloffofprogramandregainedmostofweight● Afterfollow-uplabsandmotivatingdiscussionsheresumedherprogramandsymptomsonceagainresolved

● AphonecallinSeptemberrevealedthatshewasonceagainatalossforwordsandsymptomsworsethanever.Shehadbegunintermittentfastingof18-20hours.Significantswiftweightloss.Recommendedshereturntoherprevious12-14hourfast,dietandexerciseinadditiontorelaxationactivities

Theprotocolworksbestfor:● Presymptomatics(cf.7millionE4/4,75millionE4)● SCI(subjectivecognitiveimpairment)● MCI,especiallyifMCIwithidentifiablecontributors● Peoplewithcognitivechangeswhoareotherwisehealthy.● EarlyAD,especiallyifnotalreadyondonepezilormemantine

● Theprotocolworksbestfor:•Non-type3SCI,MCI,orearlyAD● Atrophylimitedtohippocampus● Age<75

MentalHealthProfessional● ExtremelyimportanttofindMHPthatoffersNeuroPsychtesting

● Communicationbetweenproviders● Assistancewithevaluatingsafetyofclient(driving;stayingalone)

● Assistanceinevaluatinghistoryoftraumaandotherco-morbiddisease(i.e.depression)

● Supportforfamily

PeopleYouSeeatRisk● Depression● Anxiety● Insomnia● CardiovascularDisease(youmayseeafterMI)●Menopause

● 48yofemalewithhistoryoftrauma,developssevereanxietyandadmittedtolocalmentalhealthhospital.MDidentifiedthatsheneededconsult:HRT

Case2● 52yearoldmale,married,retiredAirForce●WorksfulltimeforAFbutrecentlyhisbosscounseledhimonjobperformancerelatedtomemoryissuesandinthepastfewmonthshaslefthisjob

●Wifeextremelysupportive● Loveswoodworkingandbuildingthingsinhisshop

Case2

Case2

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BredesenProtocolHealGutSleepisessentialtohealingAssessforsleepapneaMenopausal?MeditationNeuralAgilityiAwaketechnologies;CenterpointeHolosync

Nutrition● Nutritionisthemostimportantaspectoftreatment● Avoidsimplecarbs,saturatedfatsandlowfiberdiet● Hardlyanyonepresentswithagooddiet● PlantbasedwithColdWaterFish●Majorityofcaloriesfromnon-starchyvegetables(bestlocal,organic)andgoodfats.Includecookedandrawvegetables,darkgreen,rainbow,andcrucifers

● Includedetoxifyingvegetablessuchascilantro,cruciferousvegetables

Nutrition● Lowglycemicfruits● Nofruitjuice● Fish:wildcaught,SMASHfish(salmon,mackerel,anchovies,sardines,herring).AvoidfishwithhighHg(long-lived,largemouth)

●Meatiscondiment:wildgame;grassfedgrassfinished● Pasteurizedeggsandpoultry● Avoidgluten,dairy,othersensitivities● DirtydozenandCleanFifteenewg.org

PerfectGeneDiet● Plant-BasedDietwithcoldwaterfishandpoultry● Anti-inflammatorydiet● APOEgenebasedratiosofProtein/Carb/Fat● Nodairyorredmeatrecommended● Aggressivetreatmentofvascularsymptoms● ExercisebasedonAPOEgenetoassistdetoxification

● Aerobic:Anerobicratio● Mind/Bodyactivitiesemphasized

● Breathing–4-7-8● Meditation

● Theonlyprogramthathashealedgutinmypractice

TeamSherzai● TheAlzheimer’sSolution● BlueZoneLomaLinda,CA● Plant-basedMediterraneanStyleDiet(similartoPerfectGeneDiet)

● Exercise(AerobicandResistance)● Unwind:Meditation● Restore:Sleep● Optimize:Socialization,memorytechniques,music,read,volunteer,hobbies

PromisingResearch● 2015FinishGeriatricInterventionStudytoPreventCognitiveImpairmentandDisability(FINGER):1stlargeclinicaltrialtoproveitispossibletopreventcognitivedeclineusingmultidomainintervention

● 2017ColumbiaUniv:participantswhoareplant-baseddiethadalowerriskofcognitivedeclinecomparedtogroupeatingSAD(6yearspan)

● FraminghamLongitudinalStudyshowed40%reducedriskofdevelopingAlzheimer’swithbriskdailywalk

PromisingResearch● 2014WashingtonUniversityfoundthatsleep-deprivedparticipantshad>amyloidplaquedepositsandfoundplaquereductionwithimprovedsleep

● 2010meta-analysisof15studiesshowedhighlevelofphysicalactivityloweredriskby38%andlowtomoderatephysicalactivityloweredriskby35%

● 2014dietarystudyshowedeveryincrementalsteptowardabrain-healthydietresultedinadecreaseinriskofcognitivedecline

Caregivers● Anxiety● Support● Notcoveredinanyprotocol● PartnersofAlzheimer’spatienthavea600%greaterriskofdevelopingthediseasethemselvescomparedtothegeneralpopulation!!

Sharedlifestyleriskandstressaremajorfactors

Summary● IntegrativeApproachtoHeartandAlzheimer’sDisease● APOEGene● Bredesen,Sherazi,PerfectGeneDietProtocol’sforAlzheimer’scare

● CareoftheCaregiver● CareofthePractitioner

ContactInformation● InstituteforIntegralHealth,LLC

● MaryAnnOsborne,DNP,FNP● 2020WColoradoAve,CoSprings,CO80904● 719-632-9969● osbornehealth@gmail.com