The International College of Integrative Medicine (ICIM) is a not-for-profit medical organization that seeks to teach the latest research in preventative, alternative, and innovative treatments.

Members are physicians who are comfortable treating health concerns relating to circulation, the brain, the immune system, hormones, digestion, pain, and/or toxicity. Members are health professionals who are interested in utilizing more than just drugs or surgical procedures in the holistic care of our patients.

Through semiannual conferences and advanced-level trainings, ICIM seeks to fulfill their mission of providing physicians with a comprehensive understanding of integrative medical care.

The 2019 March conference covered many topics pertaining to cardiovascular disease and how to approach patients in a new light. Following is a summary of several of the presentations.

Jeffrey Dach, MD

Cardiovascular Disease, Hormones and Coronary Artery Calcium Scores

A typical cardiologist will concentrate on cholesterol scores and prescribe statins if need be. However, the new theory in cardiovascular disease suggests consideration of the Calcium Score to be a far superior predictor of coronary risk. A CAT scan is done to determine Coronary Artery Calcification, CAC. Scans that are done annually can calculate progression and risk factors. A CAC score of 0 is the best. Patients with greater than a 15% annual progression have a higher risk of heart attack.

What causes CAC to rise? Endotoxemia from leaky gut and periodontal disease seem to seed atherosclerotic plaque. Plaque gets infected with Biofilm due to Nuclear Factor Kappa B, NFKB. Plaque is an inflammatory response to infection. The annual progression of CAC score is a powerful predictor of impaired survival, heart attack and statin failure. It is important to slow the progression of the CAC score by addressing the triggers.

The theory that LDL cholesterol causes atherosclerosis has been falsified. Research shows there is no correlation. The research does support that endotoxemia causes atherosclerosis. How exactly does this happen? It begins with NFKB which is the master control over the inflammatory process. Toxins such as gram negative microorganisms stimulate the activation of NFKB which gets into the nucleus of the cell. This stimulates the production of inflammatory cytokines, TNF-a and IL-6. The release of these cytokines in micro circulation stimulates primitive stem cells to become osteoblasts which lay down calcification in the vessels. Vascular calcification represents soft tissue calcification surrounding a chronic inflammatory foci caused by infection of microorganisms.

What is the evidence of infection in atherosclerotic plaque? Mostly this is shown by sequencing the bacterial ribosome. The infections can have multiple microbes in the plaque-infected biofilm. The biofilm is infected with bacteria, fungus and protozoal organisms. Diseased tissue has been cultivated proving the presence of microorganisms. The biofilm produces an inflammatory response adding to the vicious cycle of development of atherosclerosis. In short, bacterial infections leads to biofilm, leads to inflammation, leads to plaque formation.

Where does the initial bacteria and the ultimate biofilm come from? Often times it comes from periodontal disease and leaky gut. Typically, higher levels of zonulin are found in patients with a high CAC. Zonulin is a hormone that opens the tight junctions in the gut causing leaky gut. In addition, oral and intestinal bacteria are found in coronary plaque supporting this origin.

If the CAC scores are going progressively higher each year it is an indication of active disease in the arterial wall and can represent a 17 fold increase in risk of heart attack. Research shows statin drugs actually enhance progression of the vascular calcification, partially because statins deplete Vitamin K2. However, statins do have beneficial effect as an anti-inflammatory in cases of sepsis and pneumonia and increase patient survival undergoing bypass surgery. Statins also have an antimicrobial effect at certain concentrations and can address biofilm. People with a CAC score higher than 100 may benefit from a statin, due to the inflammation. The higher the CAC score, the greater the benefit. Most importantly, with a high CAC score, the endotoxemia from bacteria, fungus and mycotoxins must be addressed.

So what should a patient do? Reverse leaky gut and endotoxemia. This in turn blocks the inflammatory cytokines blocking the infected biofilm and ultimate calcified plaque. Supplements that aid in this effort include: Vitamin C, K2, magnesium, D3, Vitamin E, garlic, essential phospholipids, and botanicals for NFKB. Biofilm disruptors include garlic, EDTA chelation, proteolytic enzymes, ozone and hyperbaric oxygen. Garlic has a profound effect on plaque reducing the amount of plaque by 60-70% in mice and humans. Botanicals that inhibit NFKB include garlic, berberine, boswellia, skullcap, curcumin, resveratrol and phosphatidylcholine. Address leaky gut issues by eliminating wheat, optimizing hormones, controlling blood sugar, using fibrinolytic enzymes, ozone and EDTA chelation. Leaky gut can be addressed by removing NSAIDs, proton pump inhibitors such as Prilosec, alcohol, wheat gluten, reactive foods, glyphosate, GMO foods and pesticides. It is beneficial to add berberine, probiotics, digestive enzymes, fiber, glutamine, colostrum and zinc. Hormonal optimization includes thyroid, estrogen and testosterone.

In summary, CAC score progression is the most powerful predictor, being a biomarkers for endotoxemia. Other useful biomarkers include HgAlc, zonulin, and LPS. Effective treatments address endotoxemia and the evolution of calcific plaque.

Su Fairchild, MD

Homocysteine

Homocysteine is a derivative of methionine converting to glutathione. It is an indirect marker for methylation. High homocysteine results in oxidative stress, resulting in inflammation and ultimately vascular inflammation, possibly leading to stroke and atherosclerosis. Low zinc, magnesium or B6 can cause high homocysteine. High homocysteine causes low levels of arginine resulting in oxidative stress. High homocysteine causes low nitric oxide leading to high inflammation and high cholesterol. High homocysteine can create oxidized LDL cholesterol and ultimately atherosclerosis. Reference ranges in men should be less than 11 and in women less than 10. Studies show harm at 8 umol. Dr. Fairchild believes it is best to be under 6.4. However, levels that are too low (less than 4) can cause issues as well including neuropathy as homocysteine is needed for the production of glutathione.

Gervasio Lamas, MD

Are Environmental Pollutants a Modifiable Risk Factor for Cardiovascular Disease?

Lead toxicity is a risk for all-cause mortality including cardiovascular mortality. Metal toxicity from cadmium, arsenic, lead and copper play a role. Peripheral artery disease is associated with cadmium exposure. Cardiovascular risk goes up with exposure to lead and cadmium. These toxins are stored in the bone and kidneys. Urinary cadmium is a good indicator of body cadmium load. Disodium Ethylene Diamine Tetraacetic Acid, EDTA, is a powerful and harmless drug to remove these contaminants from the body. Research show a 26% decrease in risk using EDTA chelation and vitamin therapy. For more information visit the Trial to Assess Chelation Therapy (TACT) website.

Barrie Tan, PhD

Cardio Metabolic Benefits of Vitamin E Tocotrienol

Vitamin E is composed of four tocopherols and four tocotrienols. Annatto is 100% tocotrienol and supports arterial health as well as reduces beta amyloid plaque in cases of Alzheimer’s. The tocophenols in Vitamin E inhibit the benefits of the tocotrienols and thus should be taken 6 hours apart. Tocotrienols lower lipids, lower inflammation, improve antioxidant levels, mitigate atherosclerosis, manage diabetes and fatty liver. Dr. Tan suggests taking tocotrienols with meals. If taking as an antioxidant, 100-200 mg per day. If needed for mild support 200-400 mg per day is appropriate. For advanced support he suggests 400-600 mg per day. For more information, visit the American River Nutrition™ website.

Patrick Theut

Cardiovascular Disease and Vitamin K2

Things that impact heart disease include: Low Vitamin K levels, Fetuin-A being out of range, APOE status, insulin and glucose levels, autoimmune issues, hormones, LDL/HDL ratios, amino acids, Vitamin C, gut bacteria, consumption of bad fats, low trace minerals, low magnesium, T3 (thyroid hormone) out of range, low Vitamin D and CoQ10, invasive critters, and dental problems. One must investigate to determine what is impacting the body. Vitamin K is essential in all aspects. It activates Fetuin A. As a result Vitamin K, Fetuin A, magnesium, Vitamin D and MK7 all work together to reverse calcium buildup in the vessels.

Peggy Daly, ND

Hidden Risks in Cardiovascular Disease

Glycocalyx is the gel layer on the artery wall. It regulates vascular permeability and quenches reactive oxygen species, ROS. If it is impaired nitric oxide decreases, oxidative stress increases, platelet adherence increases and chronic disease can result including diabetes and atherosclerosis. The level of glycocalyx can be assessed by measuring ADMA and looking at albumin/creatinine ratio. You can test for glycocalyx using sublingual microscopy and after ingestion of nitroglycerin.

It is important to assess the lipids by looking at the makeup of the LDL. For health it is desirable to have the large fluffy LDL and not beneficial to have the small dense LDL.

Lp(a) represents the inherited atherogenic and prothombotic lipoprotein. It is an independent cardiovascular risk factor. Treatment involves optimizing all other risk factors. CoQ10 can lower the Lp(a) number. Plant based diets and Vitamin K2 are also helpful.

TMAO is Trimethylamine. Eating a lot of cod and halibut can raise TMAO so beware of large consumption of these fish. TMAO can also be a renal function and vascular risk marker. Berberine, curcumin, amla, fish oil, and exercise can be helpful. Dr. Daly recommends checking for advanced lipid markers, ApoB, sd-LDL, Lp(a), metabolic markers, hs-CRP, LpPLA2, MPO, ADMA/SDMA, Il-6, Il-1B, TMAO, Microbiome, and HCY.

James Roberts, MD

Cardioheumatology

Oxidative stress is the fire behind atherosclerosis due to infection. The goal is to block HMG-Co-A reductase. One can use statins for this but instead he recommends red yeast rice extract, oil of bergamot, amla extract, or berberine. These supplements will have the same downstream effect without the side effects of statins. Mal-activation of the immune system leads to cardiovascular disease. Colchicine can help with coronary artery disease by 67%. It lowers CRP and blocks NADPH-oxidase, NFKB and NLRP3. Chondroitin sulfate is beneficial as well. Allopurinol decreases angina. It squelches oxidative stress, helps with insulin resistance, metabolic syndrome, blocks xanthine oxidase, and IMT progression. It protects the kidneys and prevents heart attack. It is indicated in cases of atherosclerosis, renal dysfunction, heart failure, diabetes, metabolic syndrome, hypertension, cardiovascular surgery and gout. The risks of this drug are rash, fever, and myalgia.

Robert Rowen, MD

Cardiovascular Disease and Ozone

Ozone is the strongest naturally occurring anti-oxidant. It upgrades the red blood cell, increases mitochondrial use of oxygen, increases nitric oxide production and synthesis, increases NAD/NADH ratio to 700:1, and modulates the immune system. Ozone preconditioning prior to surgery is very beneficial before and after the procedure. The ozone offers more O2 delivery to the tissues, helps release stem cells from the bone marrow, and is anti-inflammatory. Rectal ozone reduces TNF-A which is an inflammatory cytokine. Ozone can also be introduced through the blood and plasma. It inhibits cell aggregation, platelet aggregation, and Rouleau where the red blood cells stack like coins. Typically ejection fraction goes up with ozone therapy. Atherosclerosis is improved, as well. It addresses arrhythmia, brain circulation, and helps patients with stents. Ozone can be delivered through IV, intramuscularly, and rectally. There is no difference in how it is introduced, it just may take longer for rectal insufflation to be effective.

Anita Baxas, MD

Plaquex Therapy

Phosphatidylcholine (PC) insures optimal enzyme function. PC effects many cellular functions including carrier mediated transport of nutrients and ions, receptors for hormones, phagocytosis, endocytosis, exocytosis, and cell to cell interaction. PC helps keep the membranes fluid and is a precursor for prostaglandins, acetylcholine and eicosanoids. It protects the gastric lining. PC has an anti-glue function in the lung. It protects against aging, environmental toxins, illness, drugs, smoking, leaky gut and damage to the cell membrane. PC is needed to aid in the repair from damage done by the above. If it is deficient, the repair does not happen properly and the end result is plaque buildup. PC increases glutathione levels, helps eliminate oxidized LDL, activates Lecithin-cholesterol-acyl-transferase (LCAT) which is needed to esterify cholesterol in the vessels. It is an anti-inflammatory and anti-oxidant and attacks the biofilm in plaque.

In summary it reduces lipid peroxidation, reduces platelet aggregation, increases red blood cell fluidity, protects gastro intestinal lining, activates immune cells, is anti-inflammatory, raises HDL, lowers LDL and lowers triglycerides. It is great for general rejuvenation.

Research shows regression of atherosclerosis with PC and a vegetarian diet in animal models. It is important to use a raw unsaturated product with 90% PC from soy. The protocol involves IV treatment 2-3 times per week for 30 infusions. Specific catheters must be used and the treatment must be slow with infusions lasting 90-120 minutes each.

After the IV therapy is completed it is important to continue with a maintenance dose of oral PC and 1-2 IV follow up infusions per month. Studies have shown that the therapy must be continued as benefits will lapse if the treatment is terminated. For more information visit the Plaquex® Therapy website.

For more information

For more information about ICIM visit the International College of Integrative Medicine (ICIM) website.