Metabolic Disease

1
Metabolic Disease

• Dr. Alta Smit
• Canada
• April 2004

2
Metabolic Disease

• Disorders of fat and sugar metabolism
• Obesity
• Metabolic syndrome
• Diabetes Type I and Type II
• Disorders of calcium metabolism
• Osteopenia

3
OBESITY
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Modern Epidemic
AMBULANCE
6
Disorders of Fat and Sugar Metabolism

• Modern evidence to substantiate the
  six-phase table of disease

7
Homotoxicology
No enzyme damage Excretion principle Natural
healing tendency
Enzyme damage Compensation principle Chronic
Diseases
8
Dedifferen-tiation
Excretion
Reaction
Deposition
Degeneration
Impregnation
Central obesity
Reactive Hypogly- cemia
Colorectal Cancer Breast Myeloma Pancreas CA
Metabolic syndrome
Diabetes Mellitus Type II Osteoporosis
NASH syndrome
9
Measurement of Obesity

• Body mass index (BMI)
• Waist hip ratio (WHR)
• Sagittal abdominal diameter
• Waist measurement

• Degree of overweight/obesity-measures body fat
  and muscle mass
• Abdominal fat in relation to body size
• Fat in the abdomen
• Fat in and around the abdomen

10
WHOs Definition of Obesity

• BMI (body mass index)
• Weight (kg) is divided by
• height (m )
• E.g. Individual which weighs 90 kg and is 170 cm
  tall

2
90 kg

BMI 31
1.70 m x 1.70 m
kg 2.2 pounds m 3.3 feet
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WHOs Definition of Obesity (BMI)

• Normal weight
• Overweight
• Obesity Grade I
• Obesity Grade II
• Obesity Grade III

• 18.5- 24.9
• 25-29.9
• 30-34.9
• 35-39.4
• 40-

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WHOs Definition of ObesityUpper limits for
waist-hip ratio (WHR) and waist circumference

• Upper limits
• Waist hip ratio (WHR)
• Waist circumference
• (increased risk)
• Waist circumference
• (greatly increased risk)

• Male Female
• gt1.0 gt0.85
• 94 cm 80 cm
• 102 cm 88cm

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OBESITY

• IS IT A CHRONIC RELAPSING NEUROCHEMICAL DISEASE?

14
Neurochemistry of Appetite
Stomach secretes Ghrelin appetite
Fat tissue and pancreas facilitate the secretion
of Insulin and Leptin appetite
Source Cummings DE, Schwartz MW. Genetics and
Pathophysiology of human obesity. Annu. Rev. Med.
2003 54 453-71
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Ghrelin
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Ghrelin

• Recently discovered
• Secreted primarily by the stomach
• Interacts with neurons in the hypothalamus
• Powerfully increases short term food intake
• May decrease energy expenditure and fat
  catabolism
• Also increases body weight by other mechanisms
  than stimulating appetite

17
Hormonal Effects of Leptins

• Inhibits the secretion of
• Cortisol
• Aldosterone
• DHEA
• Reduce the secretion of catecholamines (adrenalin
  and noradrenalin)

18
Obesity

• Both leptins and insulin are increased in obese
  individuals, but the cells are resistant to it

19
Fat Tissue (more than just a filler)

• Metabolic organ
• Hormonal organ
• Immune organ

20
Fat Tissue as a Metabolic Organ

• Secretes substances called adipocytokines
• These have profound metabolic and immunological
  consequences

White adipocyte (Fat Cell)
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Fat Tissue as a Metabolic Organ

• Adipocytokines

Adiponectin
White adipocyte
TNFa
NEFA
IL-6
Resistin
Leptin
TNF tumor necrosis factor
Source Fasshauer M, Paschke R. Regulation of
adipocytokines and Insulin resistance. Diabetologi
a 2003 461594-1603
IL-6 interleukin 6
NEFA non esterified fatty acids
22
Effects of the Adipocytokines

• IL-6 Insulin resistance,
  pro-inflammatory cytokine
• TNFa Increased in obesity,
  modulates insulin
  sensitivity
• Adiponectin Important insulin sensitizer
• Leptin Major (down) regulator of food
  intake and appetite
• Resistin Modulates insulin sensitivity

23
Fat Tissue

• Gives rise to insulin resistance and the
  Metabolic Syndrome

24
Effects of adipocytokines on insulin sensitivity
?adrenergic agonists Insulin TNFa
IL-6
Adiponectin
Non esterified fatty acids NEFA
Insulin Resistance
Source Fasshauer M, Paschke R. Regulation of
adipocytokines and Insulin resistance. Diabetologi
a 2003 461594-1603
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Obesity as an Immune Syndrome

• Obesity is an inflammatory state and
• gives rise to tissue destruction and eventually
  cancer

26
Fat Tissue as an Immune Organ
TGFß
Adipocyte
INTERLEUKIN 1 TNF IL-6
TH3 and other cells
TISSUE REPAIR
TISSUE INFLAMMATION AND DEGRADATION (free
radicals)
Atherosclerosis Cancer
Tissue healing
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Inflammation Cytokines

• Cause inflammation
• Degrade tissues
• Interleukin 1
• Interleukin-6
• Interleukin-8
• Tumor necrosis factor
• From
• Macrophages
• Th1 cells
• Chondrocytes
• Fibroblasts

• Stop inflammation
• Tissue repair
• Interleukin-10
• Transforming growth factor ß
• From
• Th2 cells
• Th3 cells
• From numerous cells in the body

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Local Mediators
Histamine Serotonin Lysosomal Enzymes
Preformed granules
Prostaglandins Free radicals Nitric
oxide Cytokines
Newly synthesized
30
Traumeel Down Regulates TNFa and IL-6

• Study at Weizmann Institute

31
Fat Tissue As A Neuroendocrine Organ
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Neuro endocrine interactions
Growth hormone
Eating centre
Insulin resistance
Cortisol and aldosterone
Secretes insulin
PCOS
33
Fat Tissue

• Causes edema and high blood pressure

34
Fat Tissue as an Endocrine Organ

• Fat tissue increases the secretion of aldosterone
  from the adrenal gland
• Aldosterone (minerallocorticoid) causes water
  retention and hypertension
• Cortisol causes insulin resistance
• Growth Hormone and Insulin growth factor-1(IGF-1)

35
Fat Tissue

• Gives rise to atherosclerosis and free radical
  formation, and also hypertension

36
Fat Tissue as a Promoter of Free Radicals and
Hypertension

• Nitric oxide (NO) binds with the hydroxyradical
  (OH) to form the highly dangerous free radical,
  peroxynitrite.
• NO is needed for vasodilatation (action on smooth
  muscle). If it is decreased (obesity and
  diabetics), hypertension ensues.

37
Metabolic Syndrome

• 20-25 of US adults have it

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Metabolic Syndrome Risk Factors

• Central obesity
• Atherogenic dyslipidemia (high triglycerides and
  low HDL)
• Raised blood pressure
• Insulin resistance or glucose intolerance
• Prothrombotic state
• Pro-inflammatory state (elevated C-reactive
  protein)

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Metabolic Syndrome Diagnosis ATP III Criteria

• gt102 cm (40 in)
• gt88 cm (35 in)
• gt 150 mg/dL (1.7 mmol/L)
• lt40 mg/dL (1.0 mmol/L)
• lt50 mg/dL (1.3 mmol/L)
• gt130/gt85 mm Hg
• gt110 mg/dL (6.1 mmol/L)

• Abdominal obesity
• men
• women
• Triglyceride
• HDL cholesterol
• men
• women
• Blood pressure
• Fasting glucose

Diagnosis of metabolic syndrome is made when 3 or
more of the above risk determinants are present
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STEATOTIC HEPATITIS (NASH)
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Diabetes

• Two types
• Type 1
• Results from an absolute deficiency of insulin
• Autoimmune destruction of the ß-cells of the
  pancreas
• Genetically predisposed individuals (HLA-type)
• Initiated by a trigger (virus, chemical, etc.)

43
Diabetes

• Type II
• Much more prevalent, also now in children (MODY
  mature onset diabetes of the young)
• Results from inadequate insulin response to
  demand
• Due to insulin resistance and later inadequate
  insulin

44
Diabetes Diagnosis

• Fasting blood sugar (FBG) test is the preferred
  method
• Fasting overnight (at least 8 hrs)
• FBG of 100 mg/dL (5.5 mmol/L) is normal
• IFG (Impaired fasting blood glucose)
• 110-126 mg/dL (6.1 7.0 mmol/L)
• Diabetes
• gt 126 mg/dL (7.0 mmol/L) on two occasions
  Diabetes
• Random samples may be used if symptoms are
  present
• 200 mg/dL (11.1 mmol/L) Diabetes

45
Symptoms of Developed Diabetes

• Polyuria (excessive urination)
• Polydipsia (excessive thirst)
• Weight loss
• Blurred vision
• Impairment of growth
• Keto-acidosis

46
Long-Term Complications of Diabetes Include

• Increase in atherosclerotic cardiovascular
  peripheral vascular and cerebrovascular disease
• Peripheral neuropathy with the risk of foot
  ulcers and amputation
• Retinopathy with potential loss of vision
• Nephropathy leading to renal failure
• Autonomic neuropathy causing gastrointestinal,
  genitourinary, cardiovascular symptoms and sexual
  dysfunction
• Hypertension, Dyslipidaemia and Periodontal
  disease

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Rocks of AGE's?
48
Advanced Glycosylation End Products (AGE)

• AGEs are immunogenic
  (stimulate the inflammatory response)
• Diabetics have an increase in IL-6, TNFa, and
  free radicals, such as peroxynitrite (from NO and
  OH)
• Diabetics have less TGFß, thus tissue repair is
  decreased and inflammation is increased

Source Matsomuro et al. Diabetes 2000 49
1711-1723
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Matrix Structures

• Cells fibroblasts
• Ground substance (proteoglycans and
  glycosaminoglycans PG/GAGs)
• Three vascular structures
• Arteries
• Veins
• Lymph vessels
• Three neural structures
• Sympathetic fibres
• Parasympathetic fibres
• Sensovisceral fibres

Psycho-neuro- endocrino- immunology
50
Structure of the Matrix
Fibroblast
PAGs GAGs
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Fibroblasts and Tissue
TGFß
INTERLEUKIN 1 TNF IL-6
TH3cells
TISSUE REPAIR
TISSUE INFLAMMATION AND DEGRADATION (Free
radicals)
Atherosclerosis Cancer
Tissue healing
52
Diabetic Process in the Matrix
Hyperglycemia
Binding of glucose aldehydegroup to proteins
Auto- oxidation
Nonenzymatic glycosylation
Oxidative stress
Advanced glycation end products (AGE)
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Auto- oxidation
Oxidative stress
Reduction equivalents decrease
Free radicals increase
NFkB increases in defensive cells
Inflammatory cytokines increase
Matrix edema
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Nonenzymatic glycosylation
Development of AGE
Binding of glucose aldehydegroup to proteins
Thickening of anchor and radial fibres
Thickening of basal membrane
Circulation disturbance Capillaries and
perineurium
Disturbed lymph function
Colloidal osmotic pressure rises
Edema in the nerve sheaths
Matrix edema
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Homotoxicology
No enzyme damage Excretion principle Natural
healing tendency
Enzyme damage Compensation principle Chronic
Diseases
57
Aim of Treatment

• Treat the current condition
• Treat the complications
• Cardiovascular disease
• Peripheral vascular disease
• Renal disease
• Ocular disease
• Treat the cause and the imprint

58
Multicentric Approach
Classic Homeopathic Remedy Trace
Element Minerals Amino acids Mother
tincture Chinese Herbal Remedy Essential oil
Homotoxicological remedy
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FIRE
IMPREGNATION QUADRANT
Fear Of Rejection Failure
AGING INTOXICATION PLETHORA HYPERTENSION
POINTS SI 16. HE 1
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METABOLIC QUADRANT
EARTH
Lack of Nurturing Seeking the mother
ARTHEROSCLEROSIS DYSLIPIDEMIA GOUT DIABE
TES
SYNDROME X
INSULIN RESISTANCE
POINTSST20,SP8
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WOOD
Liver Toxic Quadrant
VIRAL INFECTIONS IRRITABILITY, ANXIETY STRESS
Decision making, planning, Anger, frustration TUPS
POINTS Liv 1, GB 24, GB 20
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Environmental imprint
Regulation failure
Phase shift
Constitution
Genetics and primitive imprints
Ontogenesis
Biological cut
Disease and organ system
Phylogenesis
64

• Choice of treatment On Phylogenesis
• Symptomatic
• Indication based
• Specific for that disease

Biological cut
Genetics And primitive imprints
Disease and Organ system
Phylogenesis
65
Environmental imprint
Regulation failure
Phase shift
Choice of treatment On Ontogenesis
Ontogenesis
Biological cut
Phase Medications REGULATION
66
Treatment Plan on Six-Phase Table
Organ regulation and immunomodulation
Detoxification
Cellular activation
ontogenesis
PPGs MPGs CPGs ORPGs
Phylo- genesis
Phase remedies catalysts and tissue
remedies (compositum)
PPGs MPGS
Symptomatic and basic remedies
and Functional support Homaccords
67
Three Pillars of HomotoxicologyTreatment of the
Metabolic Syndrome
ORGAN REGULATION AND IMMUNOMODULATION
CELLULAR ACTIVATION
DETOXIFICATION
HEPAR COMPOSITUM FUNICULUS UMBICALIS
SUIS-INJEEL PANKREAS SUIS-INJEEL TRAUMEEL CRALONIN
LYPHOSOT
GLYOXAL COMP
UBICOENZYME
68
Traumeel (Drops)
D8
D6
D4
D3
D2
Belladonna
Hammamelis
Echinacea Angustofolia
Arnica
Hepar sulf
Hypericum
Chamomilla
Calendula
Aconitum
Symphytum officinale
Millefolium
Echinacea purp
Bellis perrenis
69
Ubicoenzyme (Drops)

• D200

• D30

• D8

• D4

• D2

• Hydrastis

• Silicea

• NAD

• Oxcalic
• acid

• Succinic
• acid

• Beta
• Vulgaris

• Lipoic
• acid

• Calc
• Carb

• Thuja

• Sulphur

• Citrate

• Selenium

70
Glyoxal Compositum Ampoules
Methylglyoxalum D10 Glyoxalum D10
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Galium-Heel

• Betula albas leaves contain saponins, which have
  diuretic properties.

D12
D10
D8
D6
D5
D4
D3
D2
Galium aparine
Semperv. tectorum
Caltha palustris
Hedera Helix
Echinacea angust.
Acidum nitr.
Conium maculatum
Clematis
Ononis spinosa
Betula alba
Calcium fluoratum
Argentum
Symphytum officinale
Sedum acre
Thuja
Juniperus communis
Saponaria
Phosphorus
Apis mellifica
Urtica
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Lifestyle Changes in Metabolic Disease

• Diet low in carbohydrate and saturated fat
• Diet relatively rich in protein, especially
  organic fish
• Mediterranean diet
• Measures to reduce insulin secretion, e.g.
  protein before alcoholic drinks
• Physical exercise
• WEIGHT LOSS is the most important

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Obesity
SYMPTOMATIC
SEROL Graphites-Homaccord
Basic remedy Homaccord


Detoxification
DETOX-KIT Traumeel
SUPPORT REGULATION
Immunomodulation

UBICOENZYME

Cellular activation
INDUCE VICARIATION
Hypothalamus suis-Injeel Glandula suprarenalis
suis-Injeel Funiculus umbicalis suis-Injeel
Phase or tissue remedy
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Metabolic Syndrome
SYMPTOMATIC
Traumeel Cralonin Lithiumeel (gout) SEROL REDUCHOL
Basic remedy Homaccord


DETOXIFCATION
DETOX-KIT
SUPPORT REGULATION
FUNICULUS UMBICALIS SUIS-INJEEL
IMMUNOMODULATION

CELLULAR ACTIVATION
GLYOXAL COMPOSITUM UBICOENZYME
INDUCE VICARIATION
PHASE REMEDY Or TISSUE REMEDY

PANKREAS SUIS-INJEEL HYPOTHALAMUS
SUIS-INJEEL GLANDULA SUPRARENALIS SUIS-INJEEL
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Diabetes Type II Treat complications
SYMPTOMATIC
REDUCHOL SEROL Cralonin Lithiumeel (gout)
MAIN REMEDY SECONDARY REMEDY

Traumeel

DETOXIFCATION
DETOX-KIT
SUPPORT REGULATION
FUNICULUS UMBICALIS SUIS-INJEEL
IMMUNOMODULATION

CELLULAR ACTIVATION
GLYOXAL COMPOSITUM
INDUCE VICARIATION
PHASE REMEDY AND TISSUE REMEDY
PANKREAS SUIS-INJEEL HYPOTHALAMUS
SUIS-INJEEL GLANDULA SUPRARENALIS SUIS- INJEEL
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Diabetes Type I (Adjuvant Treatment)
SYMPTOMATIC
BASIC REMEDY

LEPTANDRA COMPOSITUM TRAUMEEL

DETOXIFICATION
DETOX-KIT
SUPPORT REGULATION
GALIUM-HEEL
IMMUNOMODULATION
UBICOENZYME GLYOXAL COMPOSITUM
CELLULAR ACTIVATION

INDUCE VICARIATION
PHASE REMEDY AND TISSUE REMEDY
PANKREAS SUIS-INJEEL VISCUM ALBUM-INJEEL (insulin
effect)
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Regulation Pyramid
Immune

Neuro endocrine
Cellular metabolism

Enterohepatic matrix toxicity

78
Three Pillar Treatment of Obesity/Metabolic
Syndrome/Diabetes Type II Weeks 1-12
10 drops/1 tablet 3x per day

• Basic remedy and Homaccord remedy
• Detox and organ activation
• Nux vomica-Homaccord
• Berberis-Homaccord
• Lyphosot
• Cellular activation
• Glyoxal compositum
• Ubicoenzyme (drops)
• Organ regeneration
• Funiculus Umbicalis suis-Injeel
• Hypothalamus suis-Injeel
• Glandula suprarenalis suis-Injeel
• Pankreas suis-Injeel

1 ampoule twice a week Ubicoenzyme 10 drops 3x
per day
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Three Pillar Treatment of Diabetes Type I Weeks
1-12
10 drops/1 tablet 3x per day

• Basic remedy and Homaccord remedy
• Detox and organ activation
• Nux vomica-Homaccord
• Berberis-Homaccord
• Lyphosot
• Cellular activation
• Glyoxal compositum
• Ubicoenzyme (drops)
• Organ regeneration
• Pankreas suis-Injeel
• Viscum album-Injeel

1 ampoule twice a week Ubicoenzyme 10 drops 3x
per day
80
Three Pillar Treatment of Obesity/Metabolic
Syndrome/Diabetes Type II Weeks 12 and after

• Basic remedy and Homaccord remedy
• Detox and organ activation
• Lyphosot
• Cellular activation
• Glyoxal compositum

10 drops/1 tablet 3x per day
Wait 6 weeks on this regime to allow for
vicariation, then repeat treatment for weeks
1-12, wait again for vicariation, then
repeat. Normally a couple of cycles are needed
until full vicariation really occurs
81
Weight Control Program

• Obesity
• Treatment
• SEROL
• Hepar compositum
• St 36
• Lyphosot
• SP 6

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Weight Control Program

• Endocrine classification
• Hypophysis
• Apple shaped
• Thick trunk
• Thin extremities
• Treatment
• Hypothalamus suis-Injeel
• Glandula suprarenalis suis-Injeel
• Glavella
• ST 23, 25, 27

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Weight Control Program

• Endocrine classification
• Pancreas
• Pear shaped
• Increased abdominal fat
• Treatment
• Pankreas suis-Injeel
• Hepar compositum
• Solar plexus
• LR 13
• ST 25, 36

84
Weight Control Program

• Endocrine classification
• Ovaries/Testicles
• Lower extremity fat
• Treatment
• Hormeel
• St 29
• Sp 6

85
Treatment of Diabetic Complications

• Cardiovascular disease (Cralonin)
• Journal of Biomedical Therapy - Spring 2004
• Antioxidant (also Ubichinon compositum)
• Antihypertensive (also Rauwolfia compositum)
• Coronary circulation (also Ateria-Heel and
  Cactus-Injeel)
• Helps cardiac failure
• Helps against hyperlipidemia (also add
  Barijodeel)
• Peripheral circulation (also Aesculus compositum)
  
• Polyneuropathy- Lyphosot/Lymphomyosot
• Nephropathy- Equisetum arvense-Injeel
• Microalbuminuria early sign
• Ocular- Oculoheel

86

• Treatment of peripheral diabetic polyneuropathy
  (PNP) with Lymphomyosot plus ?-lipoic acid vs.
  ?-lipoic acid aloneResults of a prospective,
  reference-controlled cohort study

87
Development of Diabetic Polyneuropathy
Hyperglycemia
Oxidative stress
Nonenzymatic glycosylation
Destruction of nerve sheaths
Reduction equivalents decrease
Development of AGE
Free radicals increase
Inflammatory cytokines increase
Thickening of basem. memb.
Radial/anchor fibres thickened/rigid
NFkB increases in defensive cells
edema in nerve sheaths
Circ. dist. peri-/ endoneurium
Disturbed lymph function
Matrix edema
Inflammatory cytokines increase
Colloidal osmotic pressure increases
88
Lyphosot (Drops)
D12
D6
D5
D4
D3
Geranium robertianum
Apis
Juglans regia
Urtica Urens
Myosotis arvensis
Pinus sylvestris
Scrophularia nodosa
Fumaria officinalis
Fucus Vesiculosis
Sarsaparilla
Natrum sulphuricum
Veronica officinalis
Equisetum hyemale
Calcium phosph.
Teucrium scrorodonia
Gentiana lutea
Single Homeopathic Remedies
89
Response Variables
90
Time of First Improvement
No. of patients (in )
91
Treatment Results
No. of patients (in )
92
Global Asessments
93
Osteopenia
94
Osteopenia

• Osteoporosis
• Osteomalacia
• Primary hyperparathyroidism
• Malignant disease

95
WHOs Definition of Osteoporosis

• Metabolic bone disease in which there is both a
  decrease of normally mineralized bone and the
  disturbance in bone micro-architecture
• Risk of fractures even in the absence of trauma

96
Diagnosis of Osteoporosis

• X-Ray no good
• Scans
• DEXA (dual energy X-Ray absorptiometry)
• CT scans
• Ultra sound at the heel
• Normally uses a T-score
• T score BMD-YN
• SD

BMD Bone mineral density, YN Young normal, SD
standard deviation
97
WHOs Criteria for Osteoporosis

• Normal
• Low bone mass
• Osteoporosis
• Severe osteoporosis

• BMDgt -1.0 below the young adult range
• BMD - 1 to -2.5 below
• BMD lt -2.5 below
• BMD lt -2.5 range and the patient has one or more
  fractures

98
Risk Factors for Osteoporosis

• Female, especially postmenopausal
• Race/Ethnicity Rare in African Americans and
  Mexican Americans common in Caucasians and Asians
• Diet high protein diet increases risk
• Smoking
• Alcohol
• Inactivity
• Leanness
• Coffee ingestion
• Diseases associated with secondary osteoporosis
• Cushings syndrome, Thyroid hormone suppressive
  therapy, previous gastric surgery

99
Osteoclasts/Osteoblasts
TGFß Stimulates osteoblasts
INTERLEUKIN 1 TNF Stimulate the osteoclasts
TH3 cells
TISSUE REPAIR
TISSUE INFLAMMATION AND DEGRADATION (free
radicals)
Bone mineralization
Osteoporosis
100
Treatment of Osteoporosis

• Diet low in protein
• Weight bearing activity
• Stop smoking
• Low alcohol intake
• No coffee

101
Adjuvant

• Isoflavones (Equifem-Balance 2-4 capsules per
  day)
• Calcium 1000-1500 mg/day
• Vit D 400 IU per day
• Free amino acids

102
Osteoporosis
SYMPTOMATIC
OSTEEL CALCOHEEL RANUNCULUS-HOMACCORD COLOCYNTHIS-
HOMACCORD

BASIC REMEDY HOMACCORD

DETOX-KIT
DETOXIFICATION
SUPPORT REGULATION
GALIUM-HEEL Traumeel
IMMUNOMODULATION
CELLULAR ACTIVATION

UBICOENZYME
INDUCE VICARIATION
TISSUE AND PHASE REMEDY
FUNICULUS UMBICALIS SUIS- INJEEL Tissue remedy of
choice
103
SUMMARY
104
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