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Biomedical Therapy
J o urnal o f
Volume 6, Number 1 ) 2012
Integrating Homeopathy and Conventional Medicine
Gastrointestinal Disorders
Irritable Bowel Syndrome A Review Article Bioregulatory Treatment of Hepatitis C
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Irritable Bowel Syndrome A Review Article . . . . . . . . . . . . . . 4
Around the Globe

European Congress of Integrative Medicine . . . . . . . . . . . . . . 11
W h a t E l s e i s N e w . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 From the Practice

iStockphoto.com/Rosemarie Gearhart Stafford iStockphoto.com/Dawna
Bioregulatory Treatment of Hepatitis C . . . . . . . . . . . . . . . . . . 14
Re f r e s h Yo u r H o m o t ox i c o l o g y
Gut Feelings Revisited: Evidence for a Brain-Gut Axis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Meet the Expert

Dr. Sergio Vaisman Weinstein . . . . . . . . . . . . . . . . . . . . . . . . . 23
Practical Protocols
Bioregulatory Management of Peptic Ulcer Disease . . . . . . . 24
E x p a n d y o u r Re s e a r c h K n o wl e d g e
Noninterventional Studies: An Overview . . . . . . . . . . . . . . . . 27
Re s e a r c h H i g h l i g h t s
A Multicomponent Medication Triggers Multiple Benecial Eects Related to Cognition and Neuronal Function . . . . . . . . . . . . 30
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Published by/Verlegt durch: International Academy for Homotoxicology GmbH, Bahnackerstrae 16, 76532 Baden-Baden, Germany, www.iah-online.com, e-mail: journal@iah-online.com Editor in Chief/verantwortlicher Redakteur: Dr. Alta A. Smit Editor: Dr. David W. Lescheid Managing Editor: Silvia Bartsch Print/Druck: Dinner Druck GmbH, Schlehenweg 6, 77963 Schwanau, Germany 2012 International Academy for Homotoxicology GmbH, Baden-Baden, Germany
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Content
The Importance of the Gut

Dr. Alta A. Smit
he importance of the gut in health and disease is currently attracting much attention in medicine. Gastroenterology is one of the forefronts at which integrative medicine plays a prominent role. Not only gastrointestinal, but also systemic diseases are closely related to the function of the epithelial barrier, the gut microbiome (ie, the collection of all the genes of the commensal microbiota and the corresponding proteins and metabolites), and the brain-gut axis.1 A new trend in medicine is the socalled network disease, and systems biology, in which the recognition of the complex interactions between different molecular, tissue, and organ networks is in the foreground.2,3 Recently, it has been elucidated that normal development of neural networks, immune networks, and also neuroendocrine and metabolic networks depends on the integrity of the microbiome and the brain-gut axis.4,5 Therefore, we have devoted considerable space to the introduction of this topic, from the focus article on irritable bowel syndrome, in which the disturbance of the brain-gut axis plays a major role, to a more detailed introduction of the various levels of connectivity between the brain and the gut by Dr. David W. Lescheid.
Irritable bowel syndrome is a perfect example of multiple networks playing a role and interacting with each other to produce a complex pathophysiological picture. Thus, the conventional medical treatment of this syndrome is difficult because it cannot be reduced to a single-product, single-target approach. Bioregulating therapies, through their multitarget, multicomponent approach, offer a viable solution for intervention in these kinds of syndromes. The importance of this topic is further to be seen in the section What Else Is New? Bioregulating medicines can have a powerful adjuvant effect on seemingly difficult-to-treat diseases. The case report by Dr. Arturo OByrne is evidence of this, in which biological therapies have been used to successfully treat a refractory case of hepatitis C. We continue our series on research methods by Dr. Robbert van Haselen, and our expert in this issue is Dr. Sergio Vaisman, who has had a longstanding impact on the development of homotoxicology in Chile and Latin America.
The emergence of congresses devoted to integrative medicine is a sign of the importance of this topic for health care practitioners; however, as can be seen from the article by Dr. Kerstin Rska and Dr. Bernd Seilheimer, the topic also met with a lot of interest in a purely conventional scientic congress.
Dr. Alta A. Smit
References 1. Grenham S, Clarke G, Cryan JF, Dinan TG. Brain-gut-microbe communication in health and disease. Front Physiol. 2011;2:94. doi:10.3389/fphys.2011.00094. 2. Barabsi AL, Gulbahce N, Loscalzo J. Network medicine: a network-based approach to human disease. Nat Rev Genet. 2011;12(1):56-68. doi:10.1038/nrg2918. 3. del Sol A, Balling R, Hood L, Galas D. Diseases as network perturbations. Curr Opin Biotechnol. 2010;21(4):566-571. doi:10.1016/j.copbio.2010.07.010. 4. Manco M. Gut microbiota and developmental programming of the brain: from evidence in behavioral endophenotypes to novel perspective in obesity. Front Cell Infect Microbiol. 2012;2:109. doi:10.3389/ fcimb.2012.00109. 5. Cryan JF, Dinan TG. Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nat Rev Neurosci. 2012;13(10):701-712. doi:10.1038/ nrn3346.
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Journal of Biomedical Therapy 2012 ) Vol. 6, No. 1
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Irritable Bowel Syndrome A Review Article

By David W. Lescheid, PhD, ND
Introduction Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by common symptoms of abdominal pain or cramping (with variability in location and intensity), abdominal distension and/or sensation of bloating, excessive atulence, diarrhea or constipation (or alteration between the 2 states), and mucous in stools.1,2 These symptoms can be relatively constant but most often relapsing and remitting, according to the presence or absence of specic environmental triggers.1,3,4 Usually, the disease remains chronic and recurring, with 40% of patients having the diagnosis for 10 years or longer and 70% experiencing symptoms for 1 to 9 days each month.5 Symptoms that are independently associated with IBS include the following: lethargy (relative risk [RR], 6.7), incomplete evacuation (RR, 5.2), backache (RR, 2.0), early satiety (RR, 1.8), and increased frequency of micturition (RR, 1.8).6 Irritable bowel syndrome is not a life-threatening condition but can have a serious impact on a patients daily activities and quality of life,1 including periodic bouts of pain, suffering, and direct medical expenses as well as substantial potential social and job-related consequences.2 Irritable bowel syndrome is only one of several functional bowel disorders, including functional abdominal bloating, functional constipation,
functional diarrhea, and functional abdominal pain syndrome.4 It is part of a cluster of syndromes termed central sensitivity disorders or functional somatic disorders that include bromyalgia, chronic fatigue syndrome, temporomandibular disorder, restless legs syndrome,7,8 and interstitial cystitis/painful bladder syndrome.9 Irritable bowel syndrome coexists with other functional gastrointestinal tract (GIT) disorders, especially gastroesophageal reux disease10 and dyspepsia.11 There also is close association between celiac disease and IBS,12 as well as increased risk of experiencing migraines.13
practitioners in various countries, cultural differences in seeking medical care for this condition, or some as yet undened contributing factor. Furthermore, there are several different relatively subjective criteria used to diagnose IBS (as described later), and this has been shown to affect prevalence, with the highest number using the Manning criteria, followed by the Rome I and then the Rome II criteria.5 In Westernized countries, IBS is 2 to 3 times more common in women than in men. However, IBS is not simply a disorder of women, especially in the Indian subcontinent, where 70% to 80% of the patients with IBS are male.1 Women are more likely to report abdominal pain and constipation-related symptoms, whereas men are more likely to report diarrhea-related symptoms. The differences between sexes in IBS symptoms are modest; although female sex hormones have been shown to in uence the severity of symptoms, this contribution needs to be conrmed in more clinical studies.15 Irritable bowel syndrome is usually a disorder of young people, with half of the patients experiencing symptom onset before the age of 35 years, and only 40% of patients aged 35 to 50 years when symptoms begin.2 More than 75% of IBS cases occur in persons between the ages of 25 and 64 years.1,2 Children with recurrent ab-
Epidemiology Based on conservative estimates and strict Rome-based diagnostic criteria, 7% to 10% of adults have IBS worldwide,2,14 but that number has been estimated to be closer to 15% to 20%, depending on different diagnostic criteria and country-specic data.5 The prevalence of IBS is considerably higher among the white US population than other ethnic groups, with approximately 1500 cases per 100,000 in the white population, 300 cases per 100,000 in US Hispanics, and 170 cases per 100,000 in African Americans. A clear explanation for those differences has not yet been identied.2 This variability in prevalence might reect differences in diagnostic patterns of health care
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Esophagus
Liver Duodenum Pancreas Transverse colon Ascending colon
Stomach
Descending colon
Small intestine Sigmoid colon

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Cecum
Appendix Rectum Human Digestive System
dominal pain are more likely to develop IBS during adolescence and young adulthood,1 with 14% of high school students and 6% of middle school students reported to have symptoms of the disease.1 Elderly persons have been identied as an underdiagnosed and overlooked population with IBS.16
Diagnosis The diagn osis of IBS was previously considered as a diagnosis of exclusion, but most current guidelines amend this and acknowledge that it is a distinct disease, albeit with a broad differential diagnosis.2 There are no consistent laboratory tests, imaging studies, or biological markers to diagnose IBS; therefore, symptom-based criteria, such as the Manning or Rome III criteria (currently considered the gold standard), are commonly used. To diagnose IBS using the Rome III criteria, patients must have recurrent abdominal pain or discomfort accompanied by at least two of three additional symptoms (pain relieved by
defecation, onset of pain associated with a change in stool form, or onset of pain associated with change in stool frequency).17 It should be noted that neither of these criteria have been sufficiently validated in prospective studies; therefore, their diagnostic accuracy is unknown.17 Furthermore, it is probably more accurate to consider IBS as a complex of concurrent symptoms, with each one separately having limited diagnostic value.18 A recent systematic review states that With none of the criteria showing sufficiently homogeneous and favourable results, organic disease cannot be accurately excluded by symptom-based IBS criteria alone.19 The relative subjectivity and variability of diagnostic criteria limit their utility in clinical practice and restrict the direct transferability between research studies. An additional challenge of using symptom-based criteria for diagnosis is that the symptoms of IBS are shared by numerous other organic conditions; therefore, certain pathologies should be excluded, including
inammatory bowel disease, bile acid diarrhea, small-intestinal bacterial overgrowth, celiac disease, microscopic colitis, exocrine pancreatic insufficiency, and infectious colitis.17 The identication of a signicant psychosomatic component and comorbidity with various other conditions also add difficulty to the diagnosis.1,3,17 Four different bowel patterns are commonly recognized in those with IBS: persons with greater than 25% of bowel movements with loose or watery stools (diarrhea subtype or IBS-D) or greater than 25% of bowel movements with hard or lumpy stools (constipation subtype or IBS-C), persons with mixed constipation and diarrhea (IBS-M), and persons who alternate between diarrhea and constipation (IBS-A).1,3 Another subtype, termed unsubtyped IBS (IBS-U), was recently identied in a multicenter study in China20 and in other randomized controlled trials21 using the Rome III criteria. The usefulness of this distinct categorization has been questioned because within 1
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year, 75% of patients change subtypes, and 29% switch between constipation- and diarrhea-predominant IBS.22 A recent review suggests that the reported variability in subtyping would be more consistent if the period recommended for recording stool frequency and consistency patterns was extended to 2 weeks.21 Although there have been some reports of a predominance of specic subtypes of IBS, a systematic review elucidated that there is no consistent predominance of any one subtype and concluded that IBS clinical subtypes distribution differs depending on the population evaluated, the geographical location, and the criteria employed to dene IBS and bowel habit subtypes.23
Pathophysiology The pathogenic mechanisms contributing to IBS are still incompletely known,24 although it is evident that dysfunction in any part of the braingut axis (eg, alterations in the central nervous system caused by psychological or other factors, abnormal gastrointestinal motility, or heightened visceral sensations) can contribute to its development. It is well understood that this condition is heterogeneous, with an undoubtedly multifactorial cause.25
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Several recent studies buttress the view that IBS, at least in part, has an
organic component that can be readily and easily recognized.3 A commonly considered hypothesis is that IBS is a 3-part complex of altered GIT motility, visceral hyperalgesia, and psychopathology.2,5 There are distinct aberrations in the motility of the small and large bowel and a proposed generalized hyperresponsiveness within the smooth muscle layer. This helps explain the often associated (50% of patients) symptoms of increased urinary symptoms (eg, frequency, urgency, and nocturia).1,2 There also have been more recent reports that dysfunction in the endocannabinoid system could contribute to the onset and persistence of symptoms associated with IBS,26 including perturbations in motility, secretion, and hypersensitivity.27 Hyperalgesia within the GIT can be secondary to hyperexcitability of neurons in the dorsal horn in response to peripheral tissue irritation or to descending inuences from the brain stem. Multiple factors are proposed to alter the function of neuroreceptors and afferent spinal neurons, including genetics, inammation, mechanical irritation of local nerves, dysfunction of motility, and psychological inuences.1,2 There is still no clear association between psychiatric distur bances and pathogenesis of IBS, with considerable debate on whether psychopathology incites development of IBS or vice versa. In some studies, patients who seek medical care for IBS symptoms have a higher incidence
of panic disorder, major depression, anxiety disorder, and hypochondriasis. These psychological disturbances are not commonly believed to cause or initiate the symptoms of IBS but are thought to inuence the patients perception of the symptoms and affect the clinical outcome.1,2 There is also a higher prevalence of physical and sexual abuse in patients with IBS.1,2 It is evident that various interpersonal relationships, both positive and negative, can have an impact on the course of IBS.28 The importance of the genetic contribution to IBS remains in dispute.2,29 There are several potential dietary factors that are identied as contributing to the development of IBS in susceptible people,30 including intolerances to certain foods,31,32 ingestion of malabsorbed sugars (ie, sorbitol, fructose, and lactose) and fructans,33,34 gluten sensitivity,18 and abnormal intake of certain types of dietary fats (in particular, those rich in arachidonic acid, a precursor to several proinammatory eicosanoids).35 Immunoglobulin G antibodies to ingested food may be playing a role in IBS, and food elimination can be effective in reducing its symptoms.2 Other lifestyle factors that are correlated with the development of IBS include smoking,36 alcohol abuse and/or dependency,37 and poor sleep quality.38 Excessive intake of caffeine and/or legumes and inadequate daily intake of water also might exacerbate symp-
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Reduces pain-induced stress Reduces stress-induced motility disorders
Balancing the nervous system

Parasympathetic nervous system Sympathetic nervous system
Relaxing smooth muscles
Reduces spasms and cramps Reduces spasm- and cramp- related pain
Reduces susceptibility to diarrhea and abdominal bloating Reduces mucus production
Restoring bowel function
Figure 1. Therapeutic Action of Spascupreel in the Treatment of Irritable Bowel Syndrome
toms in susceptible persons.2 All of these environmental factors, and the psychosocial factors previously discussed, could have a notable impact on the course of IBS, possibly via their ability to inuence epigenetic mechanisms.39 Recent studies have identied additional pathophysiological mechanisms. Dysregulation of the brain-gut axis; GIT infection; low-grade inltration and activation of mast cells in the intestinal mucosa, with consequent release of bioactive substances; and altered serotonin metabolism are some emerging factors of IBS patho-
genesis. Modication of small-bowel and colonic microora (ie, so-called intestinal dysbiosis) and altered gas balance may be of relevance in some subgroups of patients with IBS.24,25 The brain-gut axis is a bidirectional pathway that links higher cortical centers with visceral afferent sensation and intestinal motor function. Regulation of these connections occurs via numerous neurotransmitters found in the brain and gut (eg, cholecystokinin, vasoactive intestinal peptide, substance P, and serotonin [5-hydroxytryptamine]) that act at different sites, with varied effects on gastrointestinal motility, pain control,
emotional behavior, and immunity. Studies have shown that IBS symptoms may be related to imbalance in mucosal 5-hydroxytryptamine availability caused by defects in 5-hydroxytryptamine production, sero tonin receptors, or transporters.2 The concept of microscopic inammation, possibly at a subclinical lowgrade level,40 preceding the development of IBS25 is groundbreaking and challenges the previous theories of this syndrome having no demonstrable pathological alterations. Lowgrade mucosal inammation, in particular involving abnormal activation
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of mast cells, has been identied as a contributing factor in the pathogenesis of IBS in a recent systematic review.41 The cause of this persistent nonresolving inammation might be a breakdown in the integrity of the epithelial barrier because recent evidence has demonstrated an increase in colonic permeability, release of mediators from mucosal mast cells, and allergic disposition in patients with the disease.42 Both colonic inammation and small-bowel inammation have been substantiated in a subset of patients with IBS and in patients with the onset of IBS after infectious enteritis, known as postinfectious IBS. The risk of developing IBS increases 6-fold after GIT infection (10%-15% of adult patients) and remains elevated for at least 2 to 3 years after infection. An exposure to pathogenic organisms (eg, Campylobacter, Shigella, Salmonella, and Escherichia coli) may disrupt intestinal barrier function, alter neuromuscular function, and trigger chronic inammation, which sustain IBS symptoms.2,43 Factors that increase the risk of developing postinfectious IBS include severe and prolonged infection, female sex, younger age, antibiotic treatment for this infection, and concomitant presence of anxiety.2,43 Further ndings of small-bowel bacterial overgrowth and disrupted numbers, distribution, and types of fecal microora in patients with IBS have been heralded as a unifying mechanism for the symp-
toms of bloating and distension common to this condition.24,44 The abnormal bacterial overgrowth is believed to induce fermentation, leading to production of excess gas, which has led to effective treatments with probiotics and antibiotics.7 Individuals who are carriers of the intestinal protozoan parasite, Blastocystis, also have been recently shown to have an increased risk of developing IBS, especially if they have single-nucleotide polymorphisms in the genes encoding interleukins 8 and 10.45 Treatment The prevailing mainstream medicine approach is to treat the dominant IBS symptoms, using antispasmodics, antidiarrheals, or laxatives, often with off-label use of pharmaceutical drugs. However, it is clear that, in many cases, this approach is unsystematic and associated with a limited therapeutic potential. Moreover, the use of more than one drug to treat different symptoms increases the risk of adverse effects.46 Furthermore, there is concern that several agents used to treat IBS symptoms may exacerbate some IBS symptoms and, therefore, need to be used with caution (eg, some antidepressants can cause constipation). A recent survey in the United States found that conventional therapies for IBS-C (eg, antidepressants, antispasmodics, laxatives, ber, and stool softeners) are associated with adverse ef-
fects that negatively affect the lives of those with IBS and lead to many patients seeking medical care or missing work/school or social activities as a result of this iatrogenesis.47 Overall, there is limited evidence for the efficacy, safety, and tolerability of therapies currently available for the treatment of IBS.48 Most mainstream medical therapies used to treat IBS target only one symptom, despite a European survey indicating that less than 25% of patients have complete relief of any one symptom with existing treatments.5 Therefore, from previous descriptions, IBS is a complex disease affecting many networks in the body. To treat this disease optimally, we need an approach that is multitargeted and multicomponent. 49 Treatment should thus not only concentrate on the symptoms of IBS, but also take into account the different network perturbations and deciencies. Complementary and alternative medical therapies, such as homeopathy, acupuncture, special diets, herbal medication, and several forms of psychological treatments and hypnotherapy, are sought by many patients and are being offered by physicians as treatment options, either alone or in conjunction with conventional forms of therapy in patients with refractory symptoms. There also is considerable evidence of efficacy with comple-
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Treat constipation, bloating, and nausea: Nux vomicaHomaccord
Figure 2. Additional Individualized Treatment of Irritable Bowel Syndrome
Treat mucosal membrane dysfunction: Mucosa compositum and Coenzyme compositum*
Treat diarrhea: Diarrheel
SPAsCUPrEEL
Treat comorbid dyspepsia: Gastricumeel
Treat stress and sleep disturbances: Neurexan or Nervoheel
mentary and alternative medical therapies, including well-designed randomized controlled trials with several of these therapies, such as peppermint oil and probiotics, as well as turmeric extract, artichoke leaf extract, combination herbal medicine products, traditional Chinese medicines and acupuncture, and various forms of mind-body medicine. (The article by Yoon et al18 provides tables summarizing the evidence base for complementary and alternative medical therapies in the treatment of IBS.) The ability of medications with bioregulatory properties, and other natural health products, to inuence multiple targets simultaneously positions them well as a potentially effective approach to such a complex disorder. Spascupreel is a multitargeted, multicomponent medication that offers a holistic approach, both treating the
spasmodic component and potentially addressing the brain-gut axis. It is, thus, one of the cornerstone treatments in the condition (Figure 1). Other treatments can then be added, according to the patients specic needs, as an individualized treatment (Figure 2). Conclusion Irritable bowel syndrome is a complex disease that cannot be solved with a linear approach. A multitargeted, multicomponent therapy is necessary to target the networks involved in this disease. Medications acting in a bioregulatory manner address the pathophysiology of the disease and have an excellent tolerability prole. Therefore, they are a promising approach in providing adequate treatment to patients with IBS.|
References 1. El-Baba MF. Pediatric irritable bowel syndrome. Medscape Reference Web site. http:// emedicine.medscape.com/article/930844overview. Accessed February 2, 2012. 2. Lehrer JK. Irritable bowel syndrome. Medscape Reference Web site. http://emedicine. medscape.com/article/180389-overview. Updated January 13, 2012. Accessed February 9, 2012. 3. Talley NJ. Irritable bowel syndrome. Intern Med J. 2006;36(11):724-728. 4. Polmear A. Irritable bowel syndrome. In: Polmear A, ed. Evidence-Based Diagnosis in Primary Care. Edinburgh, Scotland: Elsevier; 2008:424-428. 5. Hungin AP, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40,000 subjects. Aliment Pharmacol Ther. 2003;17(5):643-650. 6. Maxton DG, Morris J, Whorwell PJ. More accurate diagnosis of irritable bowel syndrome by the use of non-colonic symptomatology. Gut. 1991;32(7):784-786. 7. Riedl A, Schmidtmann M, Stengel A, et al. Somatic comorbidities of irritable bowel syndrome: a systematic analysis. J Psychosom Res. 2008;64(6):573-582. 8. Yunus MB. The prevalence of bromyalgia in other chronic pain conditions. Pain Res Treat. 2012;2012:584573.
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* In Canada, replace Coenzyme compositum by Ubicoenzyme.
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9. Nickel JC, Tripp DA, Pontari M, et al. Interstitial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, bromyalgia and chronic fatigue syndrome. J Urol. 2010;184(4):1358-1363. 10. Gasiorowska A, Poh CH, Fass R. Gastroesophageal reux disease (GERD) and irritable bowel syndrome (IBS): is it one disease or an overlap of two disorders? Dig Dis Sci. 2009;54(9):1829-1834. 11. Ford AC, Marwaha A, Lim A, Moayyedi P. Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia. Clin Gastroenterol Hepatol. 2010;8(5):401-409. 12. Ford AC, Chey WD, Talley NJ, Malhotra A, Spiegel BM, Moayyedi P. Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. Arch Intern Med. 2009;169(7):651-658. 13. Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA. Migraine, bromyalgia and depression among people with IBS: a prevalence study. BMC Gastroenterol. 2006;6:26. 14. Brandt LJ, Chey WD, Foxx-Orenstein AE, et al; American College of Gastroenterology Task Force on Irritable Bowel Syndrome. An evidence-based systematic review on the management of irritable bowel syndrome. Am J Gastroenterology. 2009;104(suppl 1):S1S35. 15. Adeyemo MA, Spiegel BMR, Chang L. Meta-analysis: do irritable bowel symptoms vary between men and women? Aliment Pharmacol Ther. 2010;32(6):738-755. 16. Agrawal A, Khan MH, Whorwell PJ. Irritable bowel syndrome in the elderly: an overlooked problem? Dig Liver Dis. 2009;41(10):721724. 17. Suares NC, Ford AC. Diagnosis and treatment of irritable bowel syndrome. Discov Med. 2011;11(60):425-433. 18. Yoon SL, Grundmann O, Koepp L, Farrell L. Management of irritable bowel syndrome (IBS) in adults: conventional and complementary/alternative approaches. Altern Med Rev. 2011;16(2):134-151. 19. Jellema P, van der Windt DA, Schellevis FG, van der Horst HE. Systematic review: accuracy of symptom-based criteria for diagnosis of irritable bowel syndrome in primary care. Aliment Pharmacol Ther. 2009;30(7):695-706. 20. Yao X, Yang YS, Cui LH, et al. Subtypes of irritable bowel syndrome on Rome III criteria: a multi-center study [published online ahead of print September 19, 2011]. J Gastroenterol Hepatol. doi:10.1111/j.14401746.2011.06930.x. 21. Engsbro AL, Simren M, Bytzer P. Shortterm stability of subtypes in irritable bowel syndrome. Aliment Pharmacol Ther. 2012;35(3):350-359. 22. Par P, Gray J, Lam S, et al. Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: baseline results from LOGIC (Longitudinal Outcomes Study of Gastrointestinal Symptoms in Canada), a naturalistic study. Clin Ther. 2006;28(10):17261735. 23. Guilera M, Balboa A, Mearin F. Bowel habit subtypes and temporal patterns in irritable bowel syndrome: systematic review. Am J Gastroenterol. 2005;100(5):1174-1184. 24. Gasbarrini A, Lauritano EC, Garcovich M, Sparano L, Gasbarrini G. New insights into the pathophysiology of IBS: intestinal microora, gas production and gut motility. Eur Rev Med Pharmacol Sci. 2008;12(suppl 1):111117. 25. Sainsbury A, Ford AC. Treatment of irritable bowel syndrome: beyond ber and antispasmodic agents. Ther Adv Gastroenterol. 2011;4(2):115-127. 26. Storr M, Allescher HD. Irritable bowel syndrome: a dysfunction of the endocannabinoid system? Gastroenterology. 2012;142(2):406408. 27. Storr MA, Yce B, Andrews CN, Sharkey KA. The role of the endocannabanoid system in the pathophysiology and treatment of irritable bowel syndrome. Neurogastroenterol Motil. 2008;20(8):857-868. 28. Gerson MJ, Gerson CD. The importance of relationships in patients with irritable bowel syndrome: a review. Gastroenterol Res Pract. 2012;2012:157340. 29. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130(5):1480-1491. 30. Tighe MP, Cummings JR, Afzal NA. Nutrition and inammatory bowel disease: primary or adjuvant therapy. Curr Opin Clin Nutr Metab Care. 2011;14(5):491-496. 31. Eswaran S, Tack J, Chey WD. Food: the forgotten factor in the irritable bowel syndrome. Gastroenterol Clin North Am. 2011;40(1):141162. 32. Morcos A, Dinan T, Quigley EM. Irritable bowel syndrome: role of food in pathogenesis and management. J Dig Dis. 2009;10(4):237246. 33. Fernandez-Banares F, Esteve M, Viver JM. Fructose-sorbitol malabsorption. Curr Gastroenterol Rep. 2009;11(5):368-374. 34. Gibson PR, Newnham E, Barrett JS, Shepherd SJ, Muir JG. Review article: fructose malabsorption and the bigger picture. Aliment Pharmacol Ther. 2007;25(4):349-363. 35. Clarke G, Fitzgerald P, Hennessy AA, et al. Marked elevations in pro-inammatory polyunsaturated fatty acid metabolites in females with irritable bowel syndrome. J Lipid Res. 2010;51(5):1186-1192. 36. Fujiwara Y, Kubo M, Kohata Y, et al. Cigarette smoking and its association with overlapping gastroesophageal reux disease, functional dyspepsia, or irritable bowel syndrome. Intern Med. 2011;50(21):2443-2447. 37. Masand PS, Sousou AJ, Gupta S, Kaplan DS. Irritable bowel syndrome (IBS) and alcohol abuse or dependence. Am J Drug Alcohol Abuse. 1998;24(3):513-521. 38. Bellini M, Gemignani A, Gambaccini D, et al. Evaluation of latent links between irritable bowel syndrome and sleep quality. World J Gastroenterol. 2011;17(46):5089-5096. 39. Dinan TG, Cryan J, Shanahan F, Keeling PW, Quigley EM. IBS: an epigenetic perspective. Nat Rev Gastroenterol Hepatol. 2010;7(8):465471. 40. Keohane J, OMahony C, OMahony L, OMahony S, Quigley EM, Shanahan F. Irritable bowel syndrome-type symptoms in patients with inammatory bowel disease: a real association or reection of occult inammation? Am J Gastroenterol. 2010;105(8):17891794. 41. Ford AC, Talley NJ. Mucosal inammation as a potential etiological factor in irritable bowel syndrome: a systematic review. J Gastroenterol. 2011;46(4):421-431. 42. Vivinus-Nebot M, Dainese R, Anty R, et al. Combination of allergic factors can worsen diarrheic irritable bowel syndrome: role of barrier defects and mast cells. Am J Gastroenterol. 2012;107(1):75-81. 43. Thabane M, Marshall JK. Post-infectious irritable bowel syndrome. World J Gastroenterol. 2009;15(29):3591-3596. 44. Lin HC, Pimentel M. Bacterial concepts in irritable bowel syndrome. Rev Gastroenterol Disord. 2005;5(suppl 3):S3-S9. 45. Olivo-Diaz A, Romero-Valdovinos M, Gudio-Ramirez A, et al. Findings related to IL-8 and IL-10 gene polymorphisms in a Mexican patient population with irritable bowel syndrome infected with Blastocystis [published online ahead of print January 28, 2012]. Parasitol Res. 2012;111(1):487-491. doi:10.1007/s00436-012-2830-0 46. Goettsch WG, van den Boom G, BreekveldtPostma NS, Smout AJ, Herings RM. Treatment patterns and health care costs of mebeverine-treated IBS patients: a casecontrol study. Pharmacoepidemiol Drug Saf. 2004;13(11):803-810. 47. Lembo A. Irritable bowel syndrome medications side effects survey. J Clin Gastroenterol. 2004;38(9):776-781. 48. Tack J, Fried M, Houghton LA, Spicak J, Fisher G. Systematic review: the efficacy of treatments for irritable bowel syndrome a European perspective. Aliment Pharmacol Ther. 2006;24(2):183-205. 49. Whorwell PJ. Irritable bowel syndrome. Altern Ther Health Med. 2011;17(2)(suppl):S4-S6.
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) Around the Globe
European Congress of Integrative Medicine

Breakaway Session on Bioregulatory Medicine
By Ghassan Andraos, MD
ioregulatory medicine is an emerging science. The aim of the scientic symposium The Bioregulatory Medicine Approach: From Genomics to Clinical Application was to update the 420 registered participants to the third European Congress of Integrative Medicine on the most recent changes and ndings in this eld. Sometimes described as the bridge between natural medicine and conventional medicine, this therapeutic approach seeks to improve patient care by offering a wide range of therapeutic and diagnostic tools, leading to a more personalized therapeutic approach. In her opening remarks, Alta Smit, MD, highlighted the novel and increasingly supported shift in medical thinking towards complexity. This
includes the underlying single and multiple networks in the disease process. With this increased complexity in thinking, there also is a necessity to incorporate new technologies, with an improved ability to diagnose complexity, and for therapeutic drugs that have multiple biological targets. Bernd Seilheimer, PhD, then explained how genomic proling can be used as a tool to substantiate the action of a multitargeted medication at a cellular level. The genomic and deep-sequencing data demonstrated that these multicomponent medications do indeed have multiple targets within a model disease system. After showing that there is a scientically validated technology, with reproducible, credible evidence identifying the targets of multicomponent medications, a more complex pathological
From left to right: Alta Smit, MD; Bernd Seilheimer, PhD; Manfred Schmolz, PhD; and Bernd Wolfarth, MD.
process, such as the inammatory cascade, can be investigated. Manfred Schmolz, PhD, presented the inammatory cascade as a model for the value of network medicine, showing that inammation is a defense mechanism that ts into the systems biology thinking and complexity and that it needs to be regulated, rather than suppressed. Possible intervention points were identied along the inammatory cascade, and the value of a multitargeted therapeutic approach to modulate the inammation (ie, upregulate some targets and downregulate others) to promote synergy and avoid adverse effects, while sustaining its therapeutic benets, was substantiated. Bernd Wolfarth, MD, associate professor of sports medicine, highlighted the clinical evidence of Traumeel in the care of musculoskeletal disorders. He discussed the preclinical knowledge about its multitargeted mechanism of action, including a proof of concept from scientic support for relevant components, together with a body of clinical research built over the years and his own clinical experience and practice. He conrms that, for him, Traumeel is denitely a rstline therapy for musculoskeletal disorders. This conference conrms the potential of Bioregulatory Medicine as an effective rst-line therapy with minimal adverse effects.|
) 11
) What Else is New

Nutritional intervention may help restore homeodynamics in the intestine.
iStockphoto.com/Ostill
Recent studies have discussed the role of the enteric microbiota in the treatment of gastrointestinal disorders.
Intestinal Inammatory Factors Aect Elderly Individuals

Elderly individuals are often characterized by having chronic low levels of inammation and immune system impairment that affect both their overall health and survival. This review describes intestinal components that receive and provide signals that play a role in local and systemic inammation and immunity. These components include the following: sentinel cells, such as macrophages, dendritic cells, and mast cells concentrated in the splanchnic area, which receive simultaneous signals from commensal bacteria as well as physiological and pathological metabolic processes; endogenous immune system molecules in the intestine, such as natural killer cells and
dendritic cells, which are affected by aging and stress; and exogenous molecules in the intestine, such as the evolutionarily conserved molecules from bacteria. All of these signals interact in a network that either promotes the restoration of homeodynamics or chronic inammation if there is failed resolution of inammation, long-lasting tissue injury, or persistent infections by pathogens. Supplementation by specific nutrients, including probiotics, prebiotics, and certain vitamins, minerals, and dietary substances, may contribute to restoring homeodynamics in the intestine and, therefore, in the whole body, by modifying the inammatory pathways and by repairing any increased permeability of the epithelial barrier. Mutat Res. 2010;690(1-2):50-56.
Gut Microbiota Communicate With the Brain

Human health is affected by a bidirectional communication system between gut microbiota and the brain. Although most previous research has focused on how the brain affects the gut microora, there is increasing evidence that signals from the commensal and pathogenic bacteria in the gut also affect the brain and behavior. This particular article discusses recent studies, including those with germ-free mice. Because there is a denite signal (axis) between the brain and the gastrointestinal tract, study of the factors that affect it is important. The agents that decrease the amount of gut microbiota include antimicrobials. Future studies should focus on the molecular, cellular, and physiological aspects of the gut microbiota brain communication. Neurogastroenterol Motil. 2011;23(3):187-192. doi:10.1111/j.1365-2982.2010.01664.x
F O R P RO F E S S I ONA L U S E ON LY
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The information contained in this journal is meant for professional use only, is meant to convey general and/or specic worldwide scientic information relating to the products or ingredients referred to for informational purposes only, is not intended to be a recommendation with respect to the use of or benets derived from the products and/or ingredients (which may be different depending on the regulatory environment in your country), and is not intended to diagnose any illness, nor is it intended to replace competent medical advice and practice. IAH or anyone connected to, or participating in this publication does not accept nor will it be liable for any medical or legal responsibility for the reliance upon or the misinterpretation or misuse of the scientic, informational and educational content of the articles in this journal. The purpose of the Journal of Biomedical Therapy is to share worldwide scientic information about successful protocols from orthodox and complementary practitioners. The intent of the scientic information contained in this journal is not to dispense recipes but to provide practitioners with practice information for a better understanding of the possibilities and limits of complementary and integrative therapies. Some of the products referred to in articles may not be available in all countries in which the journal is made available, with the formulation described in any article or available for sale with the conditions of use and/or claims indicated in the articles. It is the practitioners responsibility to use this information as applicable and in a manner that is permitted in his or her respective jurisdiction based on the applicable regulatory environment. We encourage our readers to share their complementary therapies, as the purpose of the Journal of Biomedical Therapy is to join together like-minded practitioners from around the globe. Written permission is required to reproduce any of the enclosed material. The articles contained herein are not independently veried for accuracy or truth. They have been provided to the Journal of Biomedical Therapy by the author and represent the thoughts, views and opinions of the articles author.
Exposure to trac air pollution increases the risk of dying from gastric cancer.
Emotions Affect Food Intake

This study attempted to determine some of the specic connections between human emotions and feeding behavior by examining the relationship between gut signaling from specic nutrients and externally created emotions. Functional magnetic resonance imaging was used to measure the effects in the brain. The study included 12 healthy male and female volunteers who were not obese. Nutrient-induced gut-brain signaling was determined after the subjects received an infusion of fatty acid or saline. An important part of this study was that, because the volunteers received an infusion, it bypassed the taste receptors, texture, sight, and mouth-end feel associated with fatty foods, showing for the rst time in humans the direct effect of the composition of the food itself on emotions. Sad emotion was induced by validated sad or neutral classical music and facial expressions. The subjects then rated their feelings of hunger, fullness, and mood. The results indicated that sad emotion was attenuated by fatty acid infusion. These ndings increase the understanding of the relationships among emotions, hunger/ food intake, meal-induced sensations and obesity, eating disorders, functional dyspepsia, and depression. Furthermore, this study helps support the validity of phrases such as emotional overeating and comfort feeding. J Clin Invest. 2011;121(8):3094-3099. doi:10.1172/JCI46380
Cancer-Associated Death Is Affected by Density of Petroleum Stations

In Taiwan, a case-control study on air pollution and death from gastric cancer was conducted from 2004 to 2008. Data were obtained from case deaths affected by gastric cancer and control deaths affected by variables other than tumors and gastrointestinal tract diseases. Cases and controls were matched by sex, birth year, and death year; 2 substantial petroleum companies provided data for number of petroleum stations in the municipalities. The density of petroleum stations in municipalities determined the exposure to benzene and other hydrocarbons present in ambient evaporative losses of petroleum or to air emissions from motor vehicles. The study determined that persons who lived in municipalities with the highest density of petroleum stations (>75th percentile) had an increased risk of death associated with gastric cancer, when compared with persons who lived in municipalities with the lowest density of petroleum stations (25th percentile). In the future, studies should seek to determine the specic ways that traffic air pollution causes gastric cancer. J Toxicol Environ Health A. 2011;74(18):1215-1224.
Enterotypes Determined for Human Gut Microbiome

There is rapidly expanding knowledge of both the species and functional features of the human gut microbiome. The present study analyzed data from adult fecal samples of 4 different countries and 22 newly sequenced fecal metagenomes and combined them with previous data from 2 other countries to identify 3 enterotypes (robust clusters of related bacteria) that are not specic to a country or continent. These enterotypes represent well-balanced, dened microbial communities with a relatively high degree of phylogenetic and functional association between them. Although the indi vidual composition can be affected differently by diet and drugs, they are not explained by differences in body mass index, sex, age, and nationality. However, several marker genes (eg, 12 genes that associate with age) or functional variables (eg, 3 modules that associate with body mass index) were determined and could be useful for diagnosis and possible prediction of the risk of different human disorders. The robustness and predictability of the clusters also suggest that they could be used as a guide for how different human groups would respond differently to drug and diet intake. Nature. 2011;473(7346):174-180.
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iStockphoto.com/Tony Tremblay
iStockphoto.com/Selvanegra
) From the Practice
Bioregulatory Treatment of Hepatitis C

A Clinical Case Report

By Arturo OByrne, MD
Hepatitis C virus (HCV) is a small positive-sense singlestranded RNA virus that causes acute and chronic hepa titis C in humans.1 More than 170 million people worldwide are infected with HCV, covering approximately 3.3% of the worlds population.2,3
hronic progression of this disease is characterized by progressive development of brosis and cirrhosis of the liver after 20 to 25 years in 2% to 35% of those affected.4 Furthermore, patients with cirrhosis are exposed to life-threatening complications, including end-stage liver disease, esophageal variceal hemorrhage, and the development of hepatocellular carcinoma (HCC), which occurs at an incidence of 4% to 5% per year in these patients.5,6 With chronic HCV infection being the leading cause of HCC and the rst indication of liver transplantation in industrialized countries, this poses an enormous threat to worldwide public health.5,7 Hepatitis C virus has also rapidly surpassed human immunodeciency virus as a cause of death in the United States, with almost 75% of HCV-related deaths occurring among adults between the ages of 45 and 64 years.7 Transmission of the virus is parenteral and sexual, with needle sharing, unscreened blood transfusions, nonsterile tattooing or acupuncture, and
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vertical and sexual transmission being among some of the means of viral exposure. However, intravenous drug use remains the most common cause of HCV infection, especially in developed countries.7,8 There are 6 genotypes of HCV, 52 subtypes within these genotypes, and a diverse population of mutant viruses known as quasispecies within each infected individual.3 Genotype 1 (subtypes 1a and 1b) is reported to be the most frequent genotype worldwide, accounting for 40% to 80% of all isolates, but unlike HCV genotypes 2 and 3, which respond more favorably to treatment, genotypes 1 and 4 are more difficult to eradicate using current conventional medications.1,3,7 Genotype 1 also may be associated with more severe liver disease and a higher risk of HCC.7 The ability of the virus to incorporate adaptive mutations in the host and exist as genetically distinct quasispecies, in addition to disrupting the hosts defense by blocking phosphorylation and function of interferon (IFN) regulatory factor-3, an antiviral signalling molecule, poses a major challenge to
the immune-mediated control of HCV.1 This may also explain the variable clinical course of the disease, difficulties in vaccine development, and the variable results of treatment.1,8 Current pharmacological intervention includes antiviral agents that specically target viral function, collectively termed direct-acting antivirals, in addition to host-targeted agents that aim to inhibit HCV replication.8 The aim behind all treatment options is to eradicate HCV viremia, thereby increasing quality of life and reducing the risk of cirrhosis and HCC.7,8 Combination therapy of pegylated IFN- and ribavirin is the current mainstay of treatment, resulting in sustained clearance of serum HCVRNA. However, this treatment causes many adverse effects (eg, ulike symptoms, insomnia, hair loss, mood changes, pruritus, dermatitis, and hematological abnormalities, including neutropenia, anemia, and thrombocytopenia) and is only efficacious in approximately 50% of patients, with possible relapses at the end of treatment.8-10 Several host factors, such as age, stage of liver brosis, body mass index, liver steatosis, insulin resistance, ethnicity, and interleukin 28B single-nucleotide polymorphisms, and viral genotype are reported to inuence the treatment outcome.1,2,5,11 Patients infected with both acute and chronic hepatitis are usually asymptomatic, making early diagnosis difficult.4 Once symptoms occur,
) From the Practice
Possible hepatitis C virus particles from human serum after chromatographic purication
they tend to be nonspecic, with fatigue and/or malaise being the most commonly reported, in addition to a general decrease in quality of life.4,7 Thereafter, symptoms often develop as clinical ndings of extrahepatic manifestations of HCV and most commonly involve the joints, muscle, and skin (ie, arthralgias, paresthesias, myalgias, pruritus, and sicca syndrome). Patients with ongoing pathology associated with chronic hepatitis C that eventually results in organ failure can present with symptoms and signs related to synthetic dysfunction and portal hypertension (ie, ankle edema, abdominal distention, hematemesis or melena, palmar erythema, and yellowing of the eyes).7 The natural history of chronic hepatitis is ill dened because of the long latent period between inoculum and development. Severity and progression are variable but generally slow; however, host and environmental factors play a vital role in disease progression.8,11 Clinical Case In July 2006, a 55-year-old male patient presented to the clinic with
symptoms of skin irritation and pruritus. Investigations undertaken 6 months earlier reported altered levels of liver enzymes; features of fatty liver on ultrasonography, in addition to positive antibodies; an increased HCV RNA assay result of 697,000 IU/mL; and a genotype test result of type 1 subtype 1b. These features all conrmed a diagnosis of chronic hepatitis C infection. The patients medical history included having abnormal coagulation factor X since the age of 35 years, for which he received many transfusions (plasma and isolated X factor) in the past several years, which may have caused the HCV transmission and infection. The patient also reported previous and current treatment for metabolic syndrome, anxiety, and several adverse effects potentially caused by his conventional hepatitis drug therapy (ie, articular pain, insomnia, and emotional irritability). The patient has received weekly injections of 180 g peginterferon alfa-2a, in addition to an oral dose of 5 tablets of ribavirin per day for the past 5 months. The patient was also taking a combinaJournal of Biomedical Therapy 2012 ) Vol. 6, No. 1
tion angiotensin II receptor blocker and diuretic drug (candesartan); a statin/3-hydroxy-3-methyl glutarylcoenzyme A reductase inhibitor (atorvastatin); an antihyperglycemic drug (metformin); an antibrinolytic (tranexamic acid); 2 antidepressants (sertraline and mirtazapine); an acetaminophen- and codeine-based analgesic, in addition to a sedative (zolpidem); and a mood-stabilizing agent (levomepromazine). By March 2006, the hypertension and coagulation disorders were controlled; however, despite the conventional hepatitis C treatment, the viral load increased to greater than 700,000 IU/mL, with loss of appetite and sexual desire added to the adverse effects of the conventional drugs still felt by the patient. After 5 months of conventional treatment with no effect on the hepatitis C, the patient turned to bioregulatory therapy. In light of the chronicity of the infection, the extensive list of conventional drugs and their adverse effects, in addition to the multiple concomitant disease processes pres-
Photograph by Dr. Christian Schttler; licensed under the Creative Commons Namensnennung-Weitergabe unter gleichen Bedingungen Deutschland (http://creativecom-mons.org/licenses/by-sa/2.0/de/legalcode); http://de. wikipedia.org/w/index.php?title=Datei:HCV_particles.jpg&filetimesta mp=20060703221106
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) From the Practice
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ent all at the same time, it was clear that a carefully orchestrated therapy scheme, providing a combination of detoxication, supportive, reparative, and immune-enhancing activities, was to be initiated. After the rst consultation in July 2006, a combination of medications (eg, Hepar compositum, Engystol, and Galium-Heel) was given parenterally for immediate immunomodulation and tissue support, in addition to extensive nutritional supplementation (eg, vitamin B complex). The intravenous method of administering the bioregulating medications, together with the nutritional supplements, has evoked greater systemic effects in our clinic. The patient was also prescribed an oral combination of medications targeted at assisting with the reparative processes of the body, providing the necessary cellular and organ support, in particular for the hepatic, hematological, and splenic organs, and assisting with the activation of the immune system. Hepeel, Engystol, and a combination of products composed of Chelidonium-Homaccord and products containing porcine tissue materials (eg, liver, spleen, and bone marrow) and 2 bioregulatory metabolic factors (Acidum succinicum-Injeel and Acidum fumaricum-Injeel) were prescribed 3 times a day at specic intervals. Gentle detoxication was also started with the use of Hepeel and other prescribed liver cleanse formulas. At the follow-up visit 2 weeks later, Valerianaheel was pre-
scribed to assist with the insomnia, followed by homeopathically prepared ribavirin (D8 potency) and pegylated IFN (D8 potency) 2 weeks after that to assist with the adverse effects of the conventional counterparts. The latter were to be taken each once a day for 2 weeks, followed by 10 drops 3 times a week thereafter. After receiving neural therapy during the fourth consultation in September, the patient developed hematomas in all the injected sites, 24 hours after the injection therapy. These were seen as a positive development in the patients movement towards health, and an acute posology of oral Cinnamomum-Homaccord was prescribed for the next 1.5 days, in addition to Traumeel acting as an adjunct for the management of the inammatory process. The patient responded well after 48 hours of the initial crisis, displaying positive disease evolution changes. By using the electroacupuncture system, developed by Reinhold Voll, MD, and Fritz Kramer, MD, in Germany 60 years ago, the measurement of bioimpedance in the patients acupuncture points was assessed throughout the rest of the consultations, which was also used to conrm the physicians choice of medicines. After being evaluated in early October, autologous blood therapy was administered a few days
later into the indicated acupuncture points (ie, large intestine, liver, and lungs), in conjunction with several combination medications acting in a bioregulating manner and nutritional supplementation. The medications chosen continued to provide extensive tissue and organ support (eg, Hepar suis-Injeel, Pulmo suis-Injeel, and Bronchus suis-Injeel), with constant immunomodulation (eg, Galium-Heel, Engystol, and Traumeel) and activation of regulatory and enzymatic processes (eg, Ubichinon compositum and Acidum fumaricum-Injeel). Detoxication and drainage systems were also being assisted, while other medicines continued to work on repair and improvement of symptoms. On the day of receipt of the rst autologous blood injection therapy, the patient developed acute pharyngitis, which resolved spontaneously, displaying a positive lymphodermal disease evolution. By the seventh visit in mid-October, the patient reported a signicant improvement in the skin pruritus, in addition to improved and more regulated sleep patterns. The patient was advised to stop his antibrinolytic medication (tranexamic acid) in early October, with no ill effect on his current hematological values, indicating normal prothrombin time (PT) and partial thromboplastin time (PTT) levels and improved levels of neutrophils (from 110,000 to
) From the Practice
197,000 cells/L). The patient continued to receive autologous blood injection therapy each week until the follow-up visit a month later. At this time, the patient reported complete absence of the pruritus, increased energy levels, vastly improved appetite, and a general feeling of being more encouraged and emotionally more positive. Blood test results indicated further increases in eosinophil numbers and PT and PTT values (10.6 and 26.7 seconds, respectively), in addition to normal fasting glucose levels, but liver enzyme levels were still altered (ie, increased alanine aminotransferase level). One month later, in early December, electroacupuncture control testing was performed, with continued administration of weekly autologous blood injection therapy. The gastrointestinal system was being targeted, using a combination of medications, including Podophyllum compositum. By mid-December, the patient displayed an ectodermalpositive disease evolution, with dry scaly skin developing on the right foot, which, after the application of Traumeel cream, started secreting and resolving after a further 2 days. By January 10, 2007, polymerase chain reaction HCV levels were 43 IU RNA/mL, with PT and PTT levels at 16.3 and 39.9 seconds, respectively. The patient started to progressively reduce his IFN treatment, which was then completely discon-
tinued, in addition to the ribavirin, under the advice of the patients hepatologist in March 2007. Repeat blood tests in September 2007 conrmed the same minimal viral load and regulated PT and PTT levels, at 10.00 and 26.6 seconds, respectively. Twenty months later, in early 2009, an ultrasonographic investigation revealed no evidence of past fatty liver changes, and liver function test results were normal. A recent blood test, performed in July 2012, once again revealed results with a minimal viral load, indicating no signs of relapse and that the patient was maintaining self-regulation. Conclusion Hepatitis C infections, in particular with the genotype 1, subtype 1b, can be challenging to treat because the mutating virus is difficult to eradicate and the risk of developing severe liver disease and HCC is much higher in this group of patients. This 55-year-old patient was treated with several modalities because of the complexity of his health status, but medicines acting in a bioregulating manner provided the mainstay of the multilevel intervention that was necessary in this case. The host assisted in launching an effective and sustained immune response toward an evasive adversary, but the medicines also provided the necessary organ and tissue support for detoxication, tissue repair, and
regeneration, resulting in normal hepatic structure and function, with minimal adverse reactions.|
References 1. Carcamo WC, Nguyen CQ. Advancement in the development of models for hepatitis C research. J Biomed Biotechnol. 2012;2012:346761. doi:10.1155/2012/346761. 2. Hofmann WP, Sarrazin C, Zeuzem S. Current standards in the treatment of chronic hepatitis C. Dtsch Arztebl Int. 2012;109(19):352358. doi:10.3238/arztebl.2012.0352. 3. Imran M, Waheed Y, Manzoor S, et al. Interaction of hepatitis C virus proteins with pattern recognition receptors [published online ahead of print June 22, 2012]. Virol J. 2012;9(1):126. doi:10.1186/1743422X-9-126. 4. Jamall IS, Yusuf S, Azhar M, Jamall S. Is pegylated interferon superior to interferon, with ribavarin, in chronic hepatitis C genotypes 2/3? World J Gastroenterol. 2008;14(43):6627-6631. 5. Hoffmann TW, Duverlie G, Bengrine A. MicroRNAs and hepatitis C virus: toward the end of miR-122 supremacy [published online ahead of print June 12, 2012]. Virol J. 2012;9(1):109. doi:10.1186/1743422X-9-109. 6. Pawlotsky JM. New antiviral agents for hepatitis C. F1000 Biol Rep. 2012;4:5. doi:10.3410/B4-5. 7. Mukherjee S. Hepatitis C. Medscape Web site. http://emedicine.medscape.com/ article/177792-overview#a0101. Updated February 29, 2012. Accessed June 27, 2012. 8. Jafferbhoy H, Gashau W, Dillon J. Cost effectiveness and quality of life considerations in the treatment of hepatitis C infection. Clinicoecon Outcomes Res. 2010;2:87-96. doi:10.2147/CEOR.S7283. 9. Salloum S, Tai AW. Treating hepatitis C infection by targeting the host. Transl Res. 2012;159(6):421-429. doi:10.1016/j. trsl.2011.12.007. 10. Baraldi S, Hepgul N, Mondelli V, Pariante CM. Symptomatic treatment of interferon-induced depression in hepatitis C: a systematic review. J Clin Psychopharmacol. 2012;32(4):531-543. 11. Sievert W. Management issues in chronic viral hepatitis: hepatitis C. J Gastroenterol Hepatol. 2002;17(4):415-422.
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) Re f r e s h Yo u r H o m o t ox i c o l o g y
Gut Feelings Revisited: Evidence for a Brain-Gut Axis

Introduction It has been proposed since antiquity that the gut can either be a source of emotions or have a major inuence on their character and intensity. Expressions such as gut feelings or follow your gut have been commonly used for many years. The scientic support for these expressions is being substantiated, with considerable support for direct communication between the brain and the gastrointestinal tract (GIT). This article will discuss some of the recent evidence for the presence of the braingut axis, including some of the bestdescribed features, such as the cholinergic anti-inammatory pathway and the inuence of the microbiome* and macronutrients directly on the central nervous system (CNS). Recent studies buttressing the therapeutic potential of inuencing this brain-gut axis also will be discussed.
ic and abdominal cavities to innervate numerous visceral organs, including the esophagus, stomach, small intestine, proximal half of the colon as well as the heart and lungs. It supplies parasympathetic nervous system input to the liver, gallbladder, pancreas, kidneys, and upper region of the ureters and is an important relay of sensory information from the head, neck, abdomen, and thorax to the brain.1 The primary neurotransmitter used for communication between the synapses of the vagus nerve and its targets is acetylcholine, a signaling molecule with widespread function in the parasympathetic and sympathetic nervous systems.1 A pathway between the brain and the gut, using the vagus nerve as a conduit of communication, has been described as the cholinergic anti-inammatory pathway.2-4 In this pathway, afferent nerve bers from the vagus nerve receive signals from the organs and tissues they are situated in and carry these signals to the brain. Some of these signals are messages about injury, ischemia, and pathogens, as well as the levels and activities of proinammatory cytokines in the local microenvironment. In the brain, processing and sorting of these signals occurs, and the appropriate message is carried via the
efferent vagus nerve bers back to the site of origin. The activation of the appropriate acetylcholine receptors, including the 7 nicotinic acetylcholine receptors on immunocompetent cells, results in either a decrease of the local proinammatory message or a possible increase in inammation. In this way, the brain can play an active part in controlling an inammatory response at a distal site and preventing the damaging consequences of an excessive innate immune system response.2-4 This complete circuit of sensors of infection or injury (the vagus afferent nerve bers in visceral tissues), relay system, and integrator (brain and other parts of the CNS) and effectors (vagus efferent nerve bers, acetylcholine, and the target cells) is clearly involved in the maintenance of immune system homeodynamics and has been recently proposed as an inammatory reex.5 This system could function in a similar manner to reex arcs in other complex organ systems and suggests that it is important to consider sensory nerves as an integral part of the control of innate immune system responses.6 Also, it might be possible to eventually map an inammatory homunculus in the brain, with specic regions controlling different components of the inammatory response.7
Role of the Cholinergic Anti-inammatory Pathway Cranial nerve X, the vagus nerve, is well-known for its ability to inuence multiple targets outside the CNS. Many of its bers leave the vertebral column at the cervical spine and wander (Latin vagari means wandering) throughout the thorac-
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* The microbiome refers to the collection of all the genes of the commensal microbiota and the corresponding proteins and metabolites (see Turnbaugh PJ, Ley RE, Hamady M, Fraser-Liggett CM, Knight R, Gordon JI. The human microbiome project. Nature. 2007;449[7164]:804-810).
The practical ramication of this brain-gut axis, outlined by the cholinergic anti-inammatory pathway, is that therapeutic interventions, including acupuncture, biofeedback, mindfulness meditation, body work, cervical adjustments, and specic natural health products, that could potentially modify the activity of the autonomic nervous system (and, therefore, input and output of the vagus nerve) might help modify the nonresolving inammation associated with chronic diseases, such as inammatory bowel disease, rheumatoid arthritis, and type 2 diabetes mellitus.8 Moreover, because the afferent vagus nerve bers bind to acetylcholine receptors that inuence the heart, it may be possible to treat inammation by controlling the activity of the vagus nerve, via an electronic device similar to a pacemaker, and to assess the effect via a heart rate monitor.9 The potential value of this approach is supported by recent evidence demonstrating that heart rate variability is an independent marker of systemic inammatory responses and correlates well with certain biomarkers of systemic inammation, including high-sensitivity C-reactive protein (hs-CRP) and interleukin 6.10-12 Role of the Microbiome It is well substantiated that billions of microorganisms exist within our GIT and that many of them have important roles to play in our overall metabolism and health, including modulation of both innate and adaptive immune systems and synthesis and metabolism of important vitamins, hormones, and short-chain fatty acids with benecial function. The gut ora has been described as a forgotten organ because many of its essential protective, structural, and metabolic functions have been underappreciated until recently.13 However, exciting new discoveries have validated the historical view of the benet of commensal microora and have described the human intestinal microbiome as a new frontier in human biology.14 One of the most recent discoveries is the connection between the gut microbiome and the CNS to form what is termed the microbiome-gut-brain axis (Figure).15 This discovery and the studies that support it suggest that the microbes within our GITs can inuence more sophisticated nervous system functions, such as affect, motivation and higher cognitive functions, including intuitive decision making.16 This discovery also further establishes that the communication between the brain, gut, and associated microbes plays an important role in health and disease.17 Recognition that the human microbiome serves as the interface between our genes and our history of environmental exposures has led to the possibility of a mindbody-microbial continuum that has an impact into neurodevelopment and development of unique behavioral phenotypes.18 In animal studies, the acquisition of appropriate bacteria from the mother in the immediate postnatal period is an important contributing factor to the development of normal gastrointestinal, immune, neuroendocrine, and metabolic systems. It has even been shown to be one of the key factors regulating the set point
Gut-brain axis
Vagus nerve
Microbiota-gut interactions
iStockphoto.com/David Marchal (digestive system) and iStockphoto.com/Evgeny Terentev (human brain)
Influence of the microbiota on the brain and behavior
Influence of the brain on the intestinal microbiota
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Figure. The Microbiome-Gut-Brain Axis
of the hypothalamic-pituitary-adrenal (HPA) axis.19 Other studies have shown denitive changes within the brain, depending on the composition of bacteria in the GIT. For example, a recent study demonstrated that the presence or absence of commonly identied bacteria in the intestine in germ-free and specic pathogen-free mice affected the expression of Nmethyl-D-aspartate receptor, brainderived neurotrophic factor, and serotonin receptor in the different regions of the brain. These neurochemical changes were accompanied by observable changes in anxiety-like behavior.20 It was recently shown, using a mouse model, that the ingestion of a strain-specic probiotic, termed Lactobacillus rhamnosus, inuenced the expression of -aminobutyric acid receptors in different regions of the brain associated with anxiety and depression. The ingestion of these benecial bacteria also reduced anxiety and depression-related behavior associated with long-term use of corticosterone in otherwise healthy animals. Both the neurochemical and behavioral benets of the probiotic agent were negated if the vagus nerve was cut, suggesting that this nerve serves as an essential communication pathway between the brain and the gut. What this study demonstrates is that bacteria play an important role in inuencing the brain. Also, it might be possible to select and use specic microorganisms as adjunctive therapies in stress-related disorders, such as anxiety and depression.21 It provides further support for an interdependent link between the brain and the gut ora. Neurotransmitters released after commands from the CNS can affect the habitat of the microora in several ways, including altering the motility of the GIT, affecting the production of mucin and the function of epithelial cells, and directly affecting the growth of different bacteria,17 including pathogenic strains, such as Escherichia coli O157:H7.22 Conversely, gut microbiota can inuence brain and behavior via the production of metabolites that directly inuence the CNS, activate innate and adaptive immune system responses with systemic effects, and modulate neural afferent circuits to the brain.21 Certain strains of probiotics also could inuence the metabolism of tryptophan, a precursor to serotonin that has wide-ranging effects throughout the nervous system, including the CNS.23 Finally, there is evidence that gut microbiota and probiotics24 can inuence the perception of visceral and even somatic pain, suggesting that they, or their metabolites, can modulate the sensitivity of the associated nerves.23 Enteric microora and their toxins can affect enterochromaffin cells in the GIT.25 Enterochromaffin cells help regulate communication between the gut lumen and the nervous system in several ways, including direct innervation by afferent bers of the vagus nerve26 and local secretion of corticotropin-releasing hormone27 (also termed corticotropin-releasing factor). This hormone is most commonly studied as being produced in the hypothalamus, where it is an important component of the HPA axis communication pathway.1 Corticotropin-releasing factor and its related peptides have been demonstrated to be widely expressed in the colon of humans and rodents,28 where they are integral mediators of the stress response in the brain-gut axis29 and play an important role in the regulation of motility,30 permeability,31 and inammation32 in the intestines. It can be synthesized and released from dendritic cells of the innate immune system, a process that is enhanced by commensal bacteria, such as Bacteriodes vulgatus and Fusobacterium varum.33 A recent study in rats demonstrated that chronic psychosocial stress triggers reversible inammation, persistent epithelial dysfunction, and colonic hyperalgesia, largely via upregulation of corticotropin-releasing factor receptor type 1 in intestines.34 This study provides support for the role of corticotropinreleasing factor as an important messenger in the brain-gut axis and suggests that this might be one of the mechanisms responsible for the observed effects of psychosocial stress on the symptoms of irritable bowel syndrome.35 Early life stressors, such as maternal separation, have been well studied in rodent models as examples of the pathological consequences of braingut axis dysfunction.36 One of the consequences of the premature separation of rat pups from their mother during the neonatal period is immediate and prolonged changes in intestinal physiology. These functional abnormalities of the colon in rat pups after maternal deprivation can be ameliorated with the supplementation of strain-specic probiotics, at least partly because of the ability of these probiotics (Lactobacillus rhamnosus R0011 and Lactobacillus helveticus R0052) to normalize cortisone release, a marker of HPA axis activity.37 Another consequence of premature maternal separation is depressivelike symptoms, which have been shown to be reversed by the supplementation of a probiotic, Bidobacterium infantis. In this case, the probiotic normalized interleukin 6 levels, restored noradrenaline concentrations in the brainstem, and reversed the observed behavioral decits.38
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Role of Macronutrients An intriguing study by Van Oudenhove et al39 demonstrated that ingestion of fatty food by healthy nonobese volunteers, via an intragastic tube to avoid any inuence of smell, taste, or feel, substantially reduced their response to experimentally induced sadness through appropriate music and pictures. Furthermore, exposure to the same music and pictures decreased their sense of fullness after ingestion of a fatty meal.39 These interesting results suggest that ingested macronutrients can directly inuence CNS activity to affect emotions and, conversely, that the brain can affect our normal response to ingested meals. A thought-provoking commentary entitled Was Feuerbach Right: Are We What We Eat? discusses this possibility.40 These results also support the idea of fatty foods as comfort foods. Although it was not examined in the study which specic neural and hormonal pathways were involved in relaying this information between the fatty food in the gut and the CNS, some likely candidates are ghrelin and cholecystokinin. Ghrelin is a hormone produced in the gut and other parts of the GIT that has been shown to have a wide variety of functions, including stimulating appetite, modulating inammation, promoting sleep, reducing pain, and facilitating learning and memory. It also is associated with reward behaviors and mood regulation in animal models.1 A recent animal study showed that persistent psychosocial stress in male mice increased levels of ghrelin and corticosteroid in addition to triggering behaviors to seek out high-fat foods.41 These data suggest that ghrelin might be an important part of the repertory of hormones associated with the stress response. They also are an interesting support for a relatively common human behavior of preferring to eat calorie-dense comfort foods during times of high stress. Stimulation of parasympathetic nervous system terminals in the GIT by fatty acids, the corresponding release of cholecystokinin, and the subsequent secretion of pancreatic enzymes are well-established components of the digestive process.1,42 The receptors for cholecystokinin are known for their roles in learning and memory and in modulating panic, anxiety, and appetite, further demonstrating that this hormone pathway could serve as part of the brain-gut axis.1
Conclusions There is clearly a network of interactions between the brain and the gut that can be described by various plausible connections, including the vagus nerve and its associated neurotransmitters, the gut microbiome and macronutrients, and their direct and indirect inuences on CNS activity. It is intriguing to think that there might be further networks of interactions that could be included in a unifying model, including a gutbrain-skin axis,43 a gut-brain-liver axis,44 and a gutbrainexocrine pancreas axis.45 A more in-depth understanding of the interconnections between the brain and the gut will help illuminate potential therapeutic access points to treat diseases associated with a dysfunctional interaction between the CNS and the GIT, including irritable bowel syndrome,46 peptic ulcer disease, and gastroesophageal reux disorder.47 The existence of a brain-gut axis is clearly no longer a farrago of disjointed hypotheses, but an increasingly welldened bidirectional communication pathway.
The established presence of different networks contributing to the braingut axis supports the therapeutic use of multicomponent medications with the ability to affect more than one biological target simultaneously. Spascupreel is a product with evidence suggesting that it can target multiple receptors associated with this complex network, including muscarinic acetylcholine receptors (affecting smooth muscle contraction and motility), -aminobutyric acid-A (GABA type A) receptors (associated with CNS processing of mood disorders, including anxiety), and dopaminergic receptors type 2 (affecting central control of the pain response). It inhibits the enzyme monoamine oxidase B (MOA-B) (unpublished data), which is known to contribute to the regulation of levels of neurotransmitters, including dopamine. Furthermore, several of the ingredients of Spascupreel are documented in the scientic literature to modulate various central and peripheral targets of the brain-gut axis. However, the multicomponent medication Spascupreel could be considered as an important addition to a comprehensive therapeutic approach to any condition associated with a dysfunction of the brain-gut axis. Other bioregulating medications, such as Thalamus compositum (in central pain syndromes related to the GIT) and Tonsilla compositum (in disturbances of the HPA), are also used to inuence the brain-gut axis.|
) 21
References 1. Guyton AC, Hall JE. Textbook of Medical Physiology. 11th ed. Philadelphia, PA: Elsevier Inc; 2006:750-751. 2. Tracey KJ. Physiology and immunology of the cholinergic anti-inammatory pathway. J Clin Invest. 2007;117(2):289-296. 3. Gallowitsch-Puerta M, Pavlov VA. Neuro-immune interactions via the cholinergic anti-inammatory pathway. Life Sci. 2007;80(24-25):2325-2329. 4. Wang DW, Zhou RB, Yao YM. Role of cholinergic anti-inammatory pathway in regulating host response and its interventional strategy for inammatory diseases. Chin J Traumatol. 2009;12(6):355-364. 5. Andersson U, Tracey KJ. Reex principles of immunological homeostasis [published online ahead of print March 24, 2012]. Annu Rev Immunol. 2012;30:313335. doi: 10.1146/annurev-immunol-020711-075015. 6. Tracey KJ. Understanding immunity requires more than immunology. Nat Immunol. 2010;11(7):561-564. 7. Diamond B, Tracey KJ. Mapping the immunological homunculus. Proc Natl Acad Sci U S A. 2011;108(9):3461-3462. 8. Oke SL, Tracey KJ. The inammatory reex and the role of complementary and alternative medical therapies. Ann N Y Acad Sci. 2009;1172:172-180. 9. Huston JM, Tracey KJ. The pulse of inammation: heart rate variability, the cholinergic anti-inammatory pathway and implications for therapy. J Intern Med. 2011;269(1):4553. 10. von Knel R, Carney RM, Zhao S, Whooley MA. Heart rate variability and biomarkers of systemic inammation in patients with stable coronary heart disease: ndings from the Heart and Soul Study. Clin Res Cardiol. 2011;100(3):241-247. 11. Haensel A, Mills PJ, Nelesen RA, Ziegler MG, Dimsdale JE. The relationship between heart rate variability and inammatory markers in cardiovascular diseases. Psychoneuroendocrinology. 2008;33(10):1305-1312. 12. Stein PK, Barzilay JI, Chaves PH, et al. Higher levels of inammation factors and greater insulin resistance are independently associated with higher heart rate and lower heart rate variability in normoglycemic older individuals: the Cardiovascular Health Study. J Am Geriatr Soc. 2008;56(2):315321. 13. OHara AM, Shanahan F. The gut ora as a forgotten organ. EMBO Rep. 2006;7(7):688693. 14. Hattori M, Taylor TD. The human intestinal microbiome: a new frontier of human biology. DNA Res. 2009;16(1):1-12. 15. Cryan JF, OMahony SM. The microbiomegut-brain axis: from bowel to behaviour. Neurogastroenterol Motil. 2011;23(3):187192. 16. Mayer EA. Gut feelings: the emerging biology of gut-brain communication. Nat Rev Neurosci. 2011;12(8):453-466. 17. Grenham S, Clarke G, Cryan JF, Dinan TG. Brain-gut-microbe communication in health and disease. Front Physiol. 2011;2:94. 18. Gonzalez A, Stombaugh J, Lozupone C, Turnbaugh PJ, Gordon JI, Knight R. The mind-body-microbial continuum. Dialogues Clin Neurosci. 2011;13(1):55-62. 19. Sudo N, Chida Y, Aiba Y, et al. Postnatal microbial colonization programs the hypothalamic-pituitary-adrenal system for stress response in mice. J Physiol. 2004;558(pt 1):263-275. 20. Neufeld KM, Kang N, Bienenstock J, Foster JA. Reduced anxiety-like behavior and central neurochemical change in germ-free mice. Neurogastroenterol Motil. 2011;23(3):255-264. 21. Bravo JA, Forsythe P, Chew MV, et al. Ingestion of Lactobacillus strain regulates emotional behaviour and central GABA receptor expression in a mouse via the vagus nerve. Proc Natl Acad Sci U S A. 2011;108(3):16050-16055. 22. Freestone PP, Sandrini SM, Haigh RD, Lyte M. Microbial endocrinology: how stress inuences susceptibility to infection. Trends Microbiol. 2008;16(2):55-64. 23. Forsythe P, Sudo N, Dinan T, Taylor VH, Bienenstock J. Mood and gut feelings. Brain Behav Immun. 2010;24(1);9-16. 24. Kamiya T, Wang L, Forsythe P, et al. Inhibitory effects of Lactobacillus reuteri on visceral pain induced by colorectal distension in Sprague-Dawley rats. Gut. 2006;55(2):191196. 25. Nilsson O, Cassuto J, Larsson PA, et al. 5-Hydroxytryptamine and cholera secretion: a histochemical and physiological study in cats. Gut. 1983;24(6):542-548. 26. Rhee SH, Pothoulakis C, Mayer EA. Principles and clinical implications of the braingut-enteric microbiota axis. Nat Rev Gastroenterol Hepatol. 2009;6(5):306-314. 27. Kawahito Y, Sano H, Kawata M, et al. Local secretion of corticotropin-releasing hormone by enterochromaffin cells in human colon. Gastroenterology. 1994;106(4):859865. 28. Larauche M, Kiank C, Tache Y. Corticotropin releasing factor signaling in colon and ileum: regulation by stress and pathophysiological implications. J Physiol Pharmacol. 2009;60(suppl 7):33-46. 29. Fukodo S. Role of corticotropin-releasing hormone in irritable bowel syndrome and intestinal inammation. J Gastroenterol. 2007;42(suppl 17):48-51. 30. Tache Y, Perdue MH. Role of peripheral CRF signaling pathways in stress-related alterations of gut motility and mucosal function. Neurogastroenterol Motil. 2004;16(suppl 1):137-142. 31. Walton C, Yang PC, Keita AV, et al. Corticotropin-releasing hormone (CRH) regulates macromolecular permeability via mast cells in normal human colonic biopsies in vitro. Gut. 2008;57(1):50-58. 32. Buckinx R, Adriaensen D, Nassauw LV, Timmermans JP. Corticotrophin-releasing factor, related peptides, and receptors in the normal and inamed gastrointestinal tract. Front Neurosci. 2011;5:54. 33. Hojo M, Ohkusa T, Tomeoku H, et al. Corticotropin-releasing factor secretion from dendritic cells stimulated by commensal bacteria. World J Gastroenterol. 2011;17(35):4017-4022. 34. Vicario M, Alonso C, Guilarte M, et al. Chronic psychosocial stress induces reversible mitochondrial damage and corticotropin-releasing factor receptor type-1 upregulation in the rat intestine and IBS-like gut dysfunction. Psychoneuroendocrinology. 2012;37(1):65-77. 35. Lehrer J, Katz J. Irritable bowel syndrome. Medscape reference. http://emedicine.medscape.com/article/180389-overview. Updated January 13, 2012. Accessed February 9, 2012. 36. OMahony SM, Hyland NP, Dinan TG, Cryan JF. Maternal separation as a model of brain-gut axis dysfunction. Psychopharmacology (Berl). 2011;214(1):71-88. 37. Gareau MG, Jury J, MacQueen G, Sherman PM, Perdue MH. Probiotic treatment of rat pups normalises corticosterone release and ameliorates colonic dysfunction induced by maternal separation. Gut. 2007;56(11):1522-1528. 38. Desbonnet L, Garrett L, Clarke G, Kiely B, Cryan JF, Dinan TG. Effects of the probiotic Bifidobacterium infantis in the maternal separation model of depression. Neuroscience. 2010;170(4):1179-1188. 39. Van Oudenhove L, McKie S, Lassman D, et al. Fatty acidinduced gut brain signaling attenuates neural and behavioral effects of sad emotion in humans. J Clin Invest. 2011;121(8):3094-3099. 40. Cizza G, Rother KI. Was Feuerbach right: are we what we eat? J Clin Invest. 2011;121(8):2969-2971. 41. Chuang JC, Perello M, Sakata I, et al. Ghrelin mediates stress-induced food-reward behavior in mice. J Clin Invest. 2011;121(7): 2684-2692. 42. Pappas TN, Tache Y, Debas HT. Opposing central and peripheral actions of brain-gut peptides: a basis for regulation of gastric function. Surgery. 1985;98(2):183-190. 43. Arck P, Handjiski B, Hagen E, et al. Is there a gut-brain-skin axis? Exp Dermatol. 2010;19(5):401-405. 44. Wang PY, Caspi L, Lam CK, et al. Upper intestinal lipids trigger a gut-brain-liver axis to regulate glucose production. Nature. 2008;452(7190):1012-1016. 45. Konturek SJ, Zabielski R, Konturek JW, Czarnecki J. Neuroendocrinology of the pancreas: role of brain-gut axis in pancreatic secretion. Eur J Pharmacol. 2003;481(1):114. 46. Kennedy PJ, Clarke G, Quigley EM, Groeger JA, Dinan TG, Cryan JF. Gut memories: towards a cognitive neurobiology of irritable bowel syndrome. Neurosci Biobehav Res. 2012;36(1):310-340. 47. Konturek PC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. J Physiol Pharmacol. 2011;62(6):591-599.
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) Meet the Expert
Dr. Sergio Vaisman Weinstein
r. Sergio Vaisman Weinstein was born in Santiago de Chile. His father was a dermatologist, and his mother was a concert pianist. From the latter, Sergio inherited his love for music and, at the age of 8 years, started studying violin and musical theory. Unfortunately, in the fourth year of these studies, he had to stop playing the violin because of a broken arm and never recommenced. Both Sergio and his older brother shared their fathers interest in medicine. As youngsters, they accompanied him when he held his Sunday surgery at the hospital where he worked. After nishing secondary school at the Instituto Nacional in Santiago, Sergio studied medicine at the School of Medicine at the University of Chile and was awarded a Degree in Surgery before the age of 24 years. Dr. Vaisman has passed his fascination with medicine and music down to the next generation: his eldest son is a traumatologist, and his youngest daughter is a student of cello and musical composition. Dr. Vaisman likes to be out in nature and, ever since he was a boy, has enjoyed going on camping trips. He has always been a keen sportsman, playing basketball when younger and jogging for the last 25 years.
After 10 years as a physician, Dr. Vaisman fullled one of his childhood dreams and began studying for his pilots license. He continued to make progress with this hobby, passing his instrumental ying examination and subsequently qualifying to y a multiengine aircraft. Proud owner of a twin-engine aircraft with room for 6 passengers, he has covered the country from its Northern-most point (Arica) to its Southern-most point (Punta Arenas), sometimes taking sleeping bags and tents on board to allow him to combine his passions for camping and ying. After more than 30 years as a pediatrician, Dr. Vaisman felt the need to explore new avenues. This happened in light of his frustration at treating a group of patients whose conditions could only be relieved, but not cured, by conventional medicine. At this crossroads in his career, he was invited to study for a Diploma in Biological Medicine, which he accepted to explore new possibilities. He soon
realized that this was the opportunity that he had been seeking, and he continued to study at all the levels offered by the International Academy for Homotoxicology. His initial attempts to treat patients using this new approach allowed him to see for himself the excellent results obtained when applying bioregulatory therapy to pediatric patients. Because he was completely convinced that a combination of conventional medicine and bioregulation was the ideal solution, and taking advantage of his long teaching career at the University of Chile, he began to give talks to different groups of physicians throughout the country to make them aware of this approach and increase the number of professionals with an understanding of this therapy. These talks led him to coordinate a Diploma in Homotoxicology in a School of Medicine at a university in Santiago de Chile. He has also spoken at conferences and symposia and taught diploma courses in Chile, Colombia, Peru, and Portugal. His scientic contribution and support of the International Academy for Homotoxicology was recognized at the International Symposium on Bioregulatory Medicine, held in Bogota in March 2012.|
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) Practical Protocols
Bioregulatory Management of Peptic Ulcer Disease

Peptic ulcer disease (PUD) is a complex, multifactorial disease of the gastrointestinal systems common in industrialized nations.
eptic ulcer disease is the cause of mucosal defects in the portions of the gastrointestinal tract (GIT) that are exposed to acid and pepsin. These mucosal defects are termed ulcers if they extend through the muscularis mucosae. A further delineation into gastric or duodenal ulcers is used if they occur in the stomach or duodenum, respectively.1
In the United States, PUD affects approximately 4.5 million people per year, with an annual prevalence of 1.8%.1 The frequency of PUD varies considerably between different countries (eg, Japan has an annual incidence of approximately 1 case, Norway has an annual incidence of approximately 1.5 cases, and Scotland has an annual incidence of approximately 2.7 cases per 1000 population) and is determined mainly by association with the major reported causes: infection by the bacterium Helicobacter pylori and use of nonsteroidal anti-inammatory drugs (NSAIDs).1 In general, the frequency of PUD is decreasing in the developed world but increasing in developing countries.1
Peptic ulcer disease was previously considered as a disease primarily of males, but current estimates suggest more of an even distribution, with a male to female ratio of approximately 1:1. However, the average lifetime risk of developing PUD is still slightly higher in men (11%-14%) than in women (8%-11%).1 The average age of diagnosis for duodenal ulcers is between 30 and 50 years, whereas the prevalence of gastric ulcers peaks in those aged 50 to 70 years.1 Younger patients are more likely to have non H pylori, non-NSAID gastric ulcers than are more elderly patients.2 The pathogenesis of PUD is multifactorial, with contributions from several factors, including excessive acid and pepsin in the gastric lumen, defective defensive mucosal barrier components (eg, mucus, bicarbonate, and leaky intercellular junctions), impaired mucosal blood ow, cellular restitution, and epithelial cell turnover.1 However, the most commonly recognized causes are persistent infections by H pylori, the use of NSAIDs, and aspirin.1 Chronic overwhelming stress was identied historically as a major initiating factor but is now generally considered sec-
ondary to an infection by H pylori.3 There is renewed interest in dening the psychosocial etiology of PUD,4 with the recognition that the combined effect of H pylori and stress on the development of ulcers is paramount.5 This heterogeneity of causes of PUD is exemplied by numerous other contributing factors identied, including the genetic predisposition of the host and environmental factors (eg, cigarette smoking,6 excessive alcohol intake, and extreme emotional or physical stress,1,7 including childhood physical abuse8). Moreover, other medications that have been associated with the development of the gastritis preceding PUD include potassium and iron supplements and ethanol in both chronic and binge drinkers.1 The most common symptom of PUD is epigastric pain, often described as a gnawing, burning sensation that occurs 2 to 3 hours after a meal and is relieved by food and/or antacids.1,9 This pain might wake the patient at night and possibly radiate into the back. Other symptoms may include nausea, heartburn, abdominal bloating, belching, intolerance to fatty foods, and chest discomfort. Vomiting may occur if there is partial or complete obstruction of the gastric outlet, and hematemesis or melena can accompany bleeding in the GIT. In addition to epigastric tenderness, signs of melena and succussion splash also occur because of GIT bleeds and/or gas-
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tric outlet obstructions.1 Ulcers induced by NSAID use might have no overt symptoms or nonspecic physical ndings, similar to uncomplicated PUD.1 The major complications of PUD include GIT bleeds and perforations of ulcers, with the potential development to peritonitis and sepsis.1 Infection by H pylori also has been identied as one of the complex host and environmental factors that increase the risk of gastric adenocarcinoma,9 possibly because of its ability to initiate and sustain chronic nonresolving inammation.10 Although the mortality rate of PUD is relatively low, it can signicantly impair a patients well-being and quality of life and is associated with high costs for employers and health care systems.11 In most patients with uncomplicated PUD, routine laboratory tests are not helpful in the diagnosis, and radiographic and endoscopic imaging techniques are needed for conrmation.1 Establishing that there is an overwhelming infection by H pylori is considered of primary importance in most patients with peptic ulcers. This can be measured using endoscopic and invasive testing (eg, rapid urease test, histopathological analysis, and culture) or nonendoscopic and noninvasive testing (eg, serum H pylori antibody detection, fecal antigen tests, and urea breath tests).1,12 An endoscopic examination of the upper GIT is the preferred diagnostic test in the evaluation of patients with suspected PUD, whereas other tests for suspected Zollinger-Ellison syndrome include a fasting serum gastrin level and secretin stimulation tests. Chest x-ray, electrocardiographic, and computed tomographic scan results are used to exclude other conditions, such as detecting free abdominal air in the case of a perforation and myocardial infarction.1 Given the current understanding of the pathogenesis of PUD, most patients with PUD are treated for H pylori infection (with initial estimates of success in 85%-90% of cases, but values decreasing to <80%) and/or avoidance of NSAIDs, along with the appropriate use of antisecretory therapy. Eradication of H pylori is a prolonged and complicated process, most commonly with a triple-therapy approach with either amoxicillin or metronidazole, clarithromycin, and a proton pump inhibitor given twice daily
Table. Bioregulatory Treatment of Peptic Ulcer Diseasea

DET-Phase Endodermal Mucodermal Impregnation to degeneration IM CTOS Basic and/or Symptomatic Gastricumeel (gastric) Duodenoheel (duodenum) D&D Regulation Therapyb Advanced detoxification and drainage,c followed by Basic detoxification and drainage: Detox-Kitd Traumeel Mucosa compositum Coenzyme compositum* Ubichinon compositum* Optional Atropinum compositum (if there is acute pain)
Dosages: Basic therapy: 1 tablet 3 times per day. Regulation therapy: tablets, 1 tablet 3 times per day; drops, 10 drops 3 times per day; ampoules, 1 ampoule of each medication, 1 to 3 times per week. Detox-Kit, 30 drops of each medication in 1.5 L of water (drink throughout the day). Optional therapy: 1 ampoule 1 to 3 times per week.
Abbreviations: CTOS, cellular, tissue, and organ support; D&D, detoxication and drainage; DET, Disease Evolution Table; IM, immunomodulation. a As an adjunct to standard medical treatment. b Antihomotoxic regulation therapy consists of a 3-pillar approach: D&D, IM, and CTOS. c Advanced supportive detoxication and drainage consists of Hepar compositum (liver), Solidago compositum (kidney), and Thyreoidea compositum (connective tissue). d The Detox-Kit consists of Lymphomyosot, Nux vomica-Homaccord, and Berberis-Homaccord.
* In Canada, replace Coenzyme compositum and Ubichinon compositum by Ubicoenzyme. Marketed in Canada as Lyphosot.
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Photograph by Samir; licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license; http://en.wikipedia.org/wiki/Image:Deep_gastric_ulcer.png.
Gastric ulcer
for 7 to 14 days as the rst-line treatment.1 Also, proton pump inhibitors exacerbate NSAID-induced small intestinal injury, possibly by inducing dysbiosis, suggesting that it would be prudent to avoid NSAIDs during this treatment.13 Because of increasing resistance of H pylori to antibiotics, there are reports of unacceptably low treatment success and accompanying proposals to alter the therapy to potentially increase therapeutic value.14,15 The presence of H pylori needs to be initially conrmed and then shown to be eradicated because ulcers have been shown to relapse in unsuccessful H pylori elimination.1,12 There are insufficient data to support any special diet in assisting with the healing of PUD, although some studies demonstrate that the consumption of common spices in food (eg, clove, cinnamon, oregano, black pepper, turmeric, and ginger) and supplementation with certain herbal medicines can have denite benecial effects on the gastric mucosa and may be of great benet for the prevention of gastric ulcers.1,16 With the success of medical therapy, surgery has a very limited role in the management of PUD and is only recommended in refractory cases and complications of PUD (eg, obstructions, perforations, penetration, and massive GIT bleeding).1,17 With the declining success rates of conventional triple-therapy treatments, it is evident that there is an opportunity for medications with bioregulatory
properties, and other natural health products, to be used as adjunctive therapies in the treatment and prevention of recurrence of peptic ulcers. Bioregulatory Intervention A small interventional trial using medications with bioregulatory properties (ie, Gastricumeel, Nux vomicaHomaccord, Lymphomyosot, and Coenzyme compositum/Ubichinon compositum) demonstrated that this also was an effective method of eradicating H pylori and, therefore, treating one of the recognized causes of PUD.18 As previously described, there are several potential networks that can contribute to the development of PUD. The bioregulatory medical approach to treatment is shown in the Table.|
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References 1. Anand BS. Peptic ulcer disease. Medscape Reference Web site. http://emedicine.medscape.com/article/181753-overview. Accessed March 29, 2011. 2. Xia HH, Phung N, Kalantar JS, Talley NJ. Demographic and endoscopic characteristics of patients with Helicobacter pylori positive and negative peptic ulcer disease. Med J Aust. 2000;173(10):515-519. 3. Gustafson J, Welling D. No acid, no ulcer100 years later: a review of the history of peptic ulcer disease. J Am Coll Surg. 2010;210(1):110-116.
4. Jones MP. The role of psychosocial factors in peptic ulcer disease: beyond Helicobacter pylori and NSAIDs. J Psychosom Res. 2006;60(4):407-412. 5. Fink G. Stress controversies: post-traumatic stress disorder, hippocampal volume, gastroduodenal ulceration. J Neuroendocrinol. 2011;23(2):107-117. 6. Zhang L, Ren JW, Wong CC, et al. Effects of cigarette smoke and its active components on ulcer formation and healing in the gastrointestinal mucosa. Curr Med Chem. 2012;19(1):63-69. 7. Leong RW. Differences in peptic ulcer between the East and the West. Gastroenterol Clin North Am. 2009;38(2):363-379. 8. Fuller-Thomson E, Bottoms J, Brennenstuhl S, Hurd M. Is childhood physical abuse associated with peptic ulcer disease? Findings from a population-based study. J Interpers Violence. 2011;26(16):3225-3247. 9. Pritchard DM, Crabtree JE. Helicobacter pylori and gastric cancer. Curr Opin Gastroenterol. 2006;22(6):620-625. 10. Polk DB, Peek RM Jr. Helicobacter pylori: gastric cancer and beyond. Nat Rev Cancer. 2010;10(6):403-414. 11. Barkun A, Leontiadis G. Systematic review of the symptom burden, quality of life impairment and costs associated with peptic ulcer disease. Am J Med. 2010;123(4):358-366. e352. 12. Costa F, DElios MM. Management of Helicobacter pylori infection. Expert Rev Anti Infect Ther. 2010;8(8):887-892. 13. Wallace JL, Syer S, Denou E, et al. Proton pump inhibitors exacerbate NSAID-induced small intestinal injury by inducing dysbiosis. Gastroenterology. 2011;141(4):13141322,1322.e1-5. 14. Graham DY, Fischbach L. Helicobacter pylori treatment in the era of increasing antibiotic resistance. Gut. 2010;59(8):1143-1153. 15. Chuah SK, Tsay FW, Hsu PI, Wu DC. A new look at anti-Helicobacter pylori therapy. World J Gastroenterol. 2011;17(35):3971-3975. 16. Al Moeh IA. Spices, herbal xenobiotics and the stomach: friends or foes? World J Gastroenterol. 2010;16(22):2710-2719. 17. Stewart DJ, Ackroyd R. Peptic ulcers and their complications. Surgery (Oxford). 2008;26(11):452-457. 18. Ricken K-H. Clinical treatment of functional dyspepsia and Helicobacter pylori gastritis. Biomed Ther. 1997;15(3):76-81.
) E x p a n d Yo u r Re s e a r c h K n o w l e d g e
Noninterventional Studies: An Overview

By Robbert van Haselen, MSc
In the previous article in this series, I further elaborated on the different types of clinical trials; in this article, I will provide a further overview of the main types of noninterventional studies.
oninterventional studies, also called nonexperimental studies, are studies that do not involve any intervention (experimental or otherwise) on the part of the investigator. Such studies have in common the use of an observational research design. In the conduct of noninterventional studies, the same rigor must be applied as in experimental studies.1,2 The main types of noninterventional studies are summarized in Table 1. Noninterventional studies fall under the header of observational epidemiology, in which the main exposures (eg, environmental factors or treatments) are not under the direct control of the epidemiologist. Noninterventional studies can involve either populations or individual patients. The main comparative noninterventional studies are cohort studies and case-control studies. The main descriptive noninterventional studies are cross-sectional studies, case series, and case reports.4 In Table 2, the main types and characteristics of noninterventional studies are summarized.
It should be noted that the temporal perspective refers to the main temporal orientation of a particular epidemiological design and not to the data collection process itself. For instance, in cohort studies, sometimes the data are collected retrospectively after the event (eg, by linking back to records that enable the reliable identication of different levels of the exposure of interest). The latter are often called historical cohort studies, but even such a study is prospective in terms of following up the march of cohorts with different exposure levels to a health outcome of interest. Historical cohort studies are less common nowadays because of the increasing ethical barrier of privacy/data protection. Cohort studies that compare the outcomes of differently treated cohorts are possible but are particularly susceptible to selection bias: the cohorts are noncomparable with respect to other factors than the treatments of interest. The latter can be partly addressed by recording/assessing all the relevant determinants
of outcome in both cohorts and then adjusting for any confounding due to these factors during the analysis. The risk remains, however, that not all relevant determinants of outcome have been assessed and that the causal attribution of ndings to a particular treatment remains biased. There is no real solution for this problem because it is, in practice, impossible to know and validly assess all the determinants of outcome. Therefore, in medicine, investigators often resort to the next best thing for managing ignorance: randomization. Provided there are sufficient patients included, the latter ensures that the known and unknown confounders are equally distributed (without selection bias) between the treatment groups. However, randomized studies are sometimes unnecessary, inappropriate, impossible, or inadequate5; therefore, a need for noninterventional studies remains. More recently, so-called hybrid designs have been proposed, in which several clinical trials are embedded within a cohort study.6 Such innovative mixed designs may be particularly suited when the assessment of the additional value of treatment is compared with treatment as usual, and this is often relevant in complementary and alternative medicine research. Although such designs hold promise, they may not always be feasible.
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Case-control studies are primarily used for etiological research. They used to be termed retrospective because, conceptually, the temporal orientation is from the disease onset backward to the postulated causal factors. Yet, cases and controls in a case-control study are often accumulated prospectively. A further variant is the so-called nested case-control study, in which the cases and controls are drawn from the population of a larger cohort study. An advantage of such nested designs is that, because of the larger cohort study, more detailed and reliable information on the environmental (eg, nutritional) factors on the cases and controls can be obtained.
Cross-sectional studies examine the presence or absence of disease in relation to the presence or absence of other variables in each member of a representative sample of the study population at a particular point in time. In this manner, potential correlations between the presence or absence (or level) of variables in the diseased versus the nondiseased members can be determined. However, the presence of a correlation does not necessarily imply causation. The classic example of this in epidemiology is the correlation between more storks and larger families in rural areas compared with urban areas. This does not necessarily imply that the storks carry the babies! For
causal attribution, biological plausibility and prospectively collected data are a precondition. Noninterventional studies are all observational, but this should not be confused with qualitative observational studies that are different from the studies listed in Table 2. Observational methods used in the social sciences involve the systematic, detailed observation of behavior and talk: the qualitative researcher systematically watches people and events to nd out about behaviors and interactions in natural settings. Observation, in this sense, represents the idea of the researcher as the research instrument, as someone who
Table 1. Main Types of Noninterventional Studiesa

Type of Study Cohort Description of Study A group of patients or subjects with dened characteristics, which is followed up (marching forward in time). This type of study usually involves the identication of 2 or more cohorts of patients, one receiving the exposure/treatment of interest and the other(s) not, and following-up of these cohorts regarding the outcome of interest. A noninterventional study with a single cohort of patients is also possible. Such studies usually occur in routine clinical practice, with the aim to describe treatment and outcomes. A study that involves the identication of patients who have the outcome of interest and control patients who do not have the outcome of interest and then reviewing to determine if they had the exposure/treatment of interest. A study that examines the relationship between diseases and other variables of interest as they exist in a dened population in a particular point in time. A report on a series of patients with an outcome of interest. No control group is involved.
Case-control
Cross-sectional
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Case series
a
Data adapted from Porta.3
iStockphoto.com/Mutlu Kurtbas
) E x p a n d Yo u r Re s e a r c h K n o w l e d g e
goes out into the eld.4 A further elaboration on qualitative research methods is outside the scope of this article. There are now reporting guidelines for most types of studies. For comparative and cross-sectional epidemiological studies, there is the STROBE guideline.7 However, for case series and case reports, there are not yet reporting guidelines.|
References 1. Kelsey JL, Whittemore AS, Evans AS, Douglas Thompson W. Methods in Observational Epidemiology. 2nd ed. New York, NY: Oxford University Press; 1996. 2. Schnetzler G, Hayward C. Overview of guidelines and recommendations for the planning, conduct and reporting of company-sponsored observational, noninterventional studies in Europe. Pharm Med. 2011;25(4):235-244. 3. Porta M, ed. A Dictionary of Epidemiology. 5th ed. New York, NY: Oxford University Press; 2008. 4. Mays N, Pope C. Qualitative research: observational methods in health care settings. BMJ. 1995;311(6998):182-184.
5. Black N. Why we need observational studies to evaluate the effectiveness of health care. BMJ. 1996;312(7040):1215-1218. 6. Relton C, Torgerson D, OCathain A, Nicholl J. Rethinking pragmatic randomised controlled trials: introducing the cohort multiple randomised controlled trial design. BMJ. 2010;340:c1066. doi: 10.1136/bmj.c1066. 7. von Elm E, Altman DG, Egger M, Pocock SJ, Gtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-1457.
Table 2. Overview of Dierent Types of Noninterventional Studies

Type of Study Cohort: 2 or more cohorts Study Base Patient populations Temporal Perspective Prospective Focus Analytical/hypothesis testing Comment This type of cohort study is used to assess the health-related eects of environmental exposures or therapeutic interventions.
Cohort: 1 cohort
Patient populations
Prospective
Descriptive
This type of cohort study is often referred to as postmarketing surveillance study. In Germanspeaking countries, the term Anwendungsbeobachtungen is often used. Case-control studies are used to investigate the potential relationship between a suspected risk factor or attribute and disease. Cross-sectional studies are not suitable to determine a temporal sequence between cause and eect. Case series lack formal hypotheses and study protocols; if they had these characteristics, they would be cohort studies. Case reports can serve among other educational, medical, safety monitoring, or hypothesisgenerating purposes.
Case-control
Patient population
Retrospective
Analytical/hypothesis testing
Cross-sectional
Patient populations
Particular point in time
Prevalence and correlations
Case series
Patient populations
Prospective or retrospective
Descriptive
Case reports
Individual patients
Prospective or retrospective
Descriptive
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) Re s e a r c h H i g h l i g h t s
A Multicomponent Medication Triggers Multiple Beneficial Effects Related to Cognition and Neuronal Function
By Kerstin Rska, PhD, and Bernd Seilheimer, PhD
Background During the Society for Neuroscience Congress in Washington, DC, which was held from November 12 to 16, 2011, 3 posters on the benecial effects of a multicomponent natural medication, termed HE-300, on cognitive dysfunction were presented. This meeting had more than 30 000 participants and is the premier venue for neuroscientists from around the world to debut cuttingedge research on the brain and the nervous system. Introduction and Research Objective Disorders of cognition and memory, such as dementia, are complex, chronic, and multifactorial, with unknown etiology. The fact that we know little about the molecular pathways that result in cognitive decline and neuronal cell death led to the development of drugs lacking any disease-modifying effect. All therapeutic options currently available only treat the symptoms of the underlying disease. Another limiting factor comes along with modern drug discovery, which is based on a reductionist approach. The focus is always on a single target and a single molecule designed to block, ac-
tivate, or modify it. To better mirror disease complexity, future drug discovery approaches should aim at multiple targets using multicomponent medications. Our study describes the use of HE-300, a multicomponent multitargeted medica tion, to treat cognitive dysfunction and its effects on neuronal function. Materials and Methods The study included a series of genomic, in vitro, ex vivo, and in vivo experiments related to neuronal function and cognitive impairment. First, a systematic gene analysis of the whole genome (next-generation sequencing) was performed in rats after treatment with HE-300. This single-molecule sequencing technology identied gene clusters affected by HE-300 that are involved in neuronal function and cognitive decline. Second, the gene analysis data were instrumental for the development of functional assays to determine the effect of HE300 on neuronal outgrowth, synaptic transmission, and amyloid precursor protein (APP) processing. Third, several studies using a variety of behavioral animal models were performed to determine in vivo efficacy. HE-300 (1-2 mL/kg) was tested in learning and memory models,
such as spatial memory (T-maze), olfactory memory (Social Transmission of Food Preference), and methods to test memory of fear (Passive Avoidance and Contextual Fear Conditioning). A synthetic drug for the treatment of dementive disorders, donepezil, was included in the investigations as a positive control. Two different species, mice and rats, were used in scopolamine-induced memory impairment. Scopolamine, an acetylcholinesterase inhibitor, was given before HE-300 treatment, reecting the dementive state after loss of acetylcholine neurons. Results Our study revealed that the multicomponent multitargeted medication, HE-300, affects the expression of gene clusters associated with synaptic function in the rat hippocampus 2 and 3 days after treatment (Figure). The gene networks associated with -amyloid binding, cognition, and synaptic plasticity were mainly inuenced. A signicant effect on genes for APP and -secretase, 2 proteins involved in the pathology of Alzheimer disease, could be observed. Furthermore, synaptophysin, a synaptic vesicle glycoprotein, and synaptotagmin 3, a membrane-trafficking protein,
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) Re s e a r c h H i g h l i g h t s
Figure. Modeling Molecular Networks1 The illustration shows the gene network that plays a role in cognitive functions. The points marked in green display the genes that are inuenced by the multicomponent natural medication, HE-300. HE-300 signicantly reduces the gene expression of APP and BACE, which are responsible for the formation of -amyloid plaques in Alzheimer disease.
were highly inuenced in their expression levels, indicating that HE300 affects synaptic transmission. The functional assays demonstrated that HE-300 signicantly decreases soluble APP levels in neuronal cells, which was consistent for 72 hours. These data conrmed and supported the results from the genomic analysis. It is suggested that HE-300 inuences the generation of -amyloid protein, which hallmarks Alzheimer disease. Furthermore, HE-300 induces the elongation of dendrites of primary hippocampal neurons and restores age-related modications of synaptophysin messenger RNA in the rat cortex. The behavioral tests conrmed the supporting effect of HE-300 on cognitive function: HE300 not only signicantly improved natural forgetfulness, but also scopolamine-induced decits in learning and memory tests, such as the
T-maze, Passive Avoidance, Contextual Fear Conditioning, and Social Transmission of Food Preference. HE-300 attained similar efficacy as the gold standard, donepezil, in all in vivo test systems and displayed benecial effects on memory function in both species used. Discussion Our study shows that the multicomponent multitargeted medication, HE-300, enhances and improves cognitive functions on genomic, functional, and behavioral levels. The research results imply that this drug is able to inuence the development and maintenance of dementive states. Because of the nature of the medication used, the biological and clinical effects may arise from different targeted biochemical pathways involved in cognition and
learning. Therefore, HE-300 emerges as a true disease-modifying agent and may be an efficient and alternative option in the challenge to understand, treat, and defeat diseases associated with cognitive dysfunction. These data are a good foundation for future clinical studies to investigate the therapeutic effect of HE-300 in humans.|
Reference 1. Schnack C, Hellrung A, Seilheimer B, et al. A multicomponent medication (HE-300) targets the mechanisms related to Alzheimer disease: in-vitro & in-vivo assessment. Poster presented at: Neuroscience 2011; November 12-16, 2011; Washington, DC.
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Volume 6, Number 1 ) 2012

Integrating Homeopathy and Conventional Medicine

Around the Globe

W h a t E l s e i s N e w . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 From the Practice

Bioregulatory Treatment of Hepatitis C . . . . . . . . . . . . . . . . . . 14

Meet the Expert

The Importance of the Gut

Dr. Alta A. Smit

Journal of Biomedical Therapy 2012 ) Vol. 6, No. 1

Irritable Bowel Syndrome A Review Article

Liver Duodenum Pancreas Transverse colon Ascending colon

Small intestine Sigmoid colon

Appendix Rectum Human Digestive System

Reduces pain-induced stress Reduces stress-induced motility disorders

Balancing the nervous system

Relaxing smooth muscles

Reduces susceptibility to diarrhea and abdominal bloating Reduces mucus production

Restoring bowel function

Figure 1. Therapeutic Action of Spascupreel in the Treatment of Irritable Bowel Syndrome

Journal of Biomedical Therapy 2012 ) Vol. 6, No. 1

Treat constipation, bloating, and nausea: Nux vomicaHomaccord

Figure 2. Additional Individualized Treatment of Irritable Bowel Syndrome

Treat mucosal membrane dysfunction: Mucosa compositum and Coenzyme compositum*

Treat diarrhea: Diarrheel

Treat comorbid dyspepsia: Gastricumeel

Treat stress and sleep disturbances: Neurexan or Nervoheel

* In Canada, replace Coenzyme compositum by Ubicoenzyme.

Journal of Biomedical Therapy 2012 ) Vol. 6, No. 1

Journal of Biomedical Therapy 2012 ) Vol. 6, No. 1

) Around the Globe

European Congress of Integrative Medicine

Journal of Biomedical Therapy 2012 ) Vol. 6, No. 1

) What Else is New

Intestinal Inammatory Factors Aect Elderly Individuals

Gut Microbiota Communicate With the Brain

Journal of Biomedical Therapy 2012 ) Vol. 6, No. 1

Emotions Affect Food Intake

Cancer-Associated Death Is Affected by Density of Petroleum Stations

Enterotypes Determined for Human Gut Microbiome

Journal of Biomedical Therapy 2012 ) Vol. 6, No. 1

) From the Practice

Bioregulatory Treatment of Hepatitis C

A Clinical Case Report

) From the Practice

) From the Practice

) From the Practice

Gut Feelings Revisited: Evidence for a Brain-Gut Axis

Journal of Biomedical Therapy 2012 ) Vol. 6, No. 1

iStockphoto.com/David Marchal (digestive system) and iStockphoto.com/Evgeny Terentev (human brain)

Influence of the microbiota on the brain and behavior

Influence of the brain on the intestinal microbiota

Figure. The Microbiome-Gut-Brain Axis

Journal of Biomedical Therapy 2012 ) Vol. 6, No. 1

Journal of Biomedical Therapy 2012 ) Vol. 6, No. 1

Journal of Biomedical Therapy 2012 ) Vol. 6, No. 1

Journal of Biomedical Therapy 2012 ) Vol. 6, No. 1

) Meet the Expert

Dr. Sergio Vaisman Weinstein

Journal of Biomedical Therapy 2012 ) Vol. 6, No. 1

Bioregulatory Management of Peptic Ulcer Disease

Journal of Biomedical Therapy 2012 ) Vol. 6, No. 1

Table. Bioregulatory Treatment of Peptic Ulcer Diseasea