INTRODUCTION TO ENDOBIOGENY: AN INTEGRATIVE APPROACH TO MEDICINE

1
INTRODUCTION TO ENDOBIOGENYAN INTEGRATIVE
APPROACH TO MEDICINE

• By
• Jean Claude Lapraz, MD
• Kamyar M. Hedayat, MD

2
OBJECTIVES

• Introduce Endobiogeny and its component elements
• Detailed history
• Detailed physical exam
• Classical labs and imaging studies
• Biology of Functions
• Integrative assessment, then
• Therapeutic strategy
• Example application of the concepts of
  Endobiogeny to the clinical condition of
  Polycystic Ovarian Syndrome (PCOS)
• Discuss opportunities to learn the Endobiogenic
  method

3
Vignette

• 23 year old female presents with 4 year history
  of oligomenorrhea, hirsutism, acne, failure to
  conceive, 30 pounds weight gain.
• Laboratory studies reveal low-normal TSH, normal
  T3, T4, estradiol, dihydro-testosterone,
  androstenedione, but elevated fasting blood
  glucose.
• Ultrasound of uterus, ovaries unremarkable
• History suggests Polycystic Ovarian Disease, but
  endocrine, radiological studies are normal. Does
  this woman have an endocrine disorder or not?

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Introduction

• An introduction to the Endobiogenic concept
• A brief review of the history of medicine and its
  schools of thought

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Endobiogeny

• The integrative study of the functional
  mechanisms of regulation of the organism in its
  basic structure during homeostasis as well as its
  functional response to internal and external
  stressors
• As a whole system
• In its individual units of function
• core metabolism
• cell, tissue and organ
• in and of themselves and in relationship to each
  other
• Endobiogeny evaluates the qualitative and
  quantitative state of the human organism and its
  internal milieu.

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EXAMPLE QUANTITATIVE ASSESSMENT

• Consider a car factory to be like the ovaries.
  Does the number of cars (amount of estrogen)
  produced tell you how efficiently the factory
  (ovaries) is functioning or how well the cars
  produced drive?
• A quantitative assessment of productivity tells
  you how many cars are being produced (serum
  estrogen levels), but not how well those cars
  drive (endocrine and metabolic activity of
  estrogen).
• For example, if the output of cars meets demand,
  but the gear shifter is faulty (altered
  estrogen-receptor binding), each car carries
  fewer people than its normal capacity due to
  decreased torque. In this case, more cars will be
  needed to carry people.
• Normal factory output for this company (body)
  is insufficient to meet demand

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EXAMPLE QUALITATIVE ASSESSMENT

• But what about a qualitative assessment? There
  may be supply issuesnot enough steel available.
  The factory cannot produce cars without steel
  (cholesterol as a precursor to estrogen
  production)
• Perhaps there are not enough workers on the
  assembly line (Follicle stimulating hormone) and
  the workers present are over-worked and will soon
  decline in productivity (pituitary stress).
• Perhaps there are ample supplies and workers, but
  the manager is inefficient (hypothalamus) in
  managing the factory, not regulating supply and
  demand issues.

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Example Qualitative assessment

• Perhaps the manager is efficient, but the workers
  do not always follow his directives (altered
  thresholds of responsiveness).
• Thus, it is clear that both a quantitative and
  qualitative assessment of physiological and
  endocrine activity is necessary to properly
  understand disease and health.

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Endocrine management

• Thus, Endobiogeny views the endocrine system as
  the manager of the body, the controller of
  anabolism and catabolismwhich is what life
  itself is at every level from the cell to the
  structure of the universe
• destruction and reconstruction
• expansion and contraction
• growth and apoptosis
• birth and death

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LEVELS OF MANAGEMENT IN THE BODY
Internal terrain
Neuro-transmitters
Mental-Emotional
Mind-Body
Neuro-Endocrine
Endobiogeny
Cell receptors
Standard Medicine
Enzymes, co-factors, vitamins
Functional Medicine
External Terrain
Environmental Medicine
Toxins, Microbes, Metals
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Philosophy

• Endobiogeny integrates the rational and empirical
  schools of medicine with philosophy to create a
  single coherent system of medicine
• PHILOSOPHY The Endobiogenic approach begins with
  the ontology (reason for existence) of structures
  and physiology
• This leads to a logical approach to understanding
  structural weaknesses in the organism as well as
  determining the true cause of disease

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Rationalism

• The rational school of medicine has been the
  predominant Western school of medicine
• Relies on deductive reasoning, anatomy and
  physiology as the basis of its approach to
  illness.
• Nosology Patients are categorized by disease,
  and diseases are categorized by symptoms
• Medications are chosen based on biochemical or
  empirical effects on symptoms or physiological
  signs such as blood pressure or laboratory
  measurements
• Biomedicine (Allopathy) is the best-known form of
  rational medicine
• Modern herbalism has rationalist tendencies

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Rationalism (cont.)

• Endobiogeny is based upon
• Modern physiology and contemporary understanding
  of neuro-endocrinology
• Consideration of role of genetic polymorphisms,
  environmental toxins, stress, cytokines, cells,
  organs, and their products of metabolism in the
  origins of health and illness.
• Consideration that the organism contains in
  itself a fundamental auto-pathogenicity
  (potential for a specific disorder) which implies
  a particular risk of disease.
• Endobiogeny considers the mechanistic,
  reductionistic concepts of life insufficient to
  explain the complexity of the human organism
• Endobiogeny treats the person, not the disease,
  thus rejecting standardized treatment protocols

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Empiricism

• Refers to a system of medicine where the
  practitioners impression of illness and
  assessment of the individuals expression of
  dysfunction is the basis of treatment.
• Empirical medicine considers the energetics of
  the individual as well as the energetics of the
  treatment
• Chinese medicine and Homeopathy are forms of
  empirical medicine.

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Empiricism (cont.)

• Endobiogeny shares an emphasis on detailed
  history and careful physical exam to understand
  the unique physical and emotional antecedents of
  disease and its physiognomic expressions in the
  individual
• However, Endobiogeny seeks to find coherence in
  this information through physiological
  explanations
• In sum, Endobiogeny is an integration that takes
  into account various levels of the individual
  physical, emotional and mental, in their
  relationship with the endocrine management of the
  body and everything under its control with its
  regulatory mechanisms

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Integration of data

• Endobiogeny integrates
• History
• Physical Exam
• Laboratory data and imaging
• To reach a conclusion regarding the current,
  dynamic physiological state of the individual in
  order to formulate a treatment strategy which
  addresses
• the identified imbalances individually
• as well as in their relationship to other
  imbalances

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Treatment Options

• Endobiogenic treatments consist of various
  therapeutic elements based on their safety and
  efficacy with no prejudice to the origin of the
  treatment
• Phytotherapeutic elements
• Homeopathic elements
• Pharmaceuticals elements reasoned usage based on
  severity of symptoms, of degree or lack of
  compensatory physiology.
• Physical manipulations craniosacral, myofascial,
  etc.
• Diet and Nutrition
• Trace elements
• Stress modification, hydrotherapy, acupuncture,
  etc.

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Individualized medicine

• Endobiogeny is individualized medicine based on
• The patients symptomization of illness within
  the context of the global functioning of the
  organism
• The physicians determination of the signs of
  physiological and endocrine dysfunction
• The physicians objective assessment of endocrine
  relationships
• The particular physical, physiological,
  psychological and emotional realities of the
  individual.

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Conclusion

• Endobiogenic treatment is determined by the
  totality of the person
• Static and dynamic aspects of the patients
  constitution
• Etiology, ontology, and integration of symptoms
• Adaptive and maladaptive aspects of physiology

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The Endobiogenic Method
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Patient history

• HISTORY A detailed history of antecedent events,
  including perinatal history, childhood
  personality, illnesses, vaccinations and
  important emotional events is solicited to
  establish the constitutional and functional
  endocrine state of the patient.
• Dietary preferences, sleep habits, dreams,
  menstrual history, various aspects of behavior
  and review of systems are explored to establish
  neuro-endocrine patterns
• The trajectory of structural hormonal imbalances
  is followed throughout life, not just with
  respect to the outward manifestation of illness
  and dysfunction

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Physical Exam

• A detailed physical exam from head to toe
  evaluates the phenotypic expression of
  neuro-endocrine relationships
• Because the endocrine system manages both the
  structural integrity of the body as well as its
  functional expression, one is able to look for
  the phenotypic expressions of endocrine activity
  and correlate it with the internal state of the
  patient
• Many of these findings are easily explained by
  classical endocrinological assessment of hormonal
  activity

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Laboratory studies

• Classical lab data is based on binary
  considerations
• disease vs. no disease
• normal vs. abnormal value
• The patient in our vignette presented with normal
  levels of all the relevant hormones. Can we
  conclude that these hormones are functioning
  normally, or even that their relative levels are
  appropriate?
• Of course not. The history, symptoms and physical
  exam suggest otherwise.
• Thus, it is self-evident that binary
  considerations cannot be applied with any real
  assurance of its functional relevance to a system
  as complex as the human body.

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Laboratory studies

• Biological systems are complex, multi-tiered,
  dynamic interrelated and integrated systems

Yeast Protein Interaction Network
Integrated, inter-related system
Bader and Hogue (2002) Nature
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Integrated systems

• Objective quantitative data (laboratory values)
  are required to assess the organism
• However, one must be able to provide functional
  descriptions of quantitative and qualitative
  activity both within a particular unit of
  activity, from one unit to another, as well as
  within the system as a whole
• Only then can a truly dynamic and individualized
  assessment of the patient occur

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Laboratory studies

• The endocrine system, as the manager of the
  metabolic activity of the body, is the ideal
  object of evaluation.
• Serum levels of hormones reflect neither the
  degree of stimulation needed nor the metabolic
  costs incurred in producing a particular hormone.
• Raison CL, Miller AH. When not enough is too
  much the role of insufficient glucocorticoid
  signaling in the pathophysiology of
  stress-related disorders. Am J Psychiatry. Sep
  2003160(9)1554-1565
• Chiam K, Tilley WD, Butler LM, Bianco-Miotto T.
  The dynamic and static modification of the
  epigenome by hormones A role in the
  developmental origin of hormone related cancers.
  Biochem Biophys Acta. Apr 20091795(2)104-109.
• Gerhard I, Waibel S, Daniel V, Runnebaum B.
  Impact of heavy metals on hormonal and
  immunological factors in women with repeated
  miscarriages. Hum Reprod Update. May-Jun
  19984(3)301-309.

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Laboratory studies

• Serum levels of hormones only reflect
  quantitative organ output, not functional
  activity, which can be affected by
• Hormone receptor binding (affected by over- or
  under-expression of other hormones)1
• Intracellular messenger activity1
• Epigenetic changes2
• Heavy metal toxicity3, etc.
• Raison CL, Miller AH. When not enough is too
  much the role of insufficient glucocorticoid
  signaling in the pathophysiology of
  stress-related disorders. Am J Psychiatry. Sep
  2003160(9)1554-1565
• Chiam K, Tilley WD, Butler LM, Bianco-Miotto T.
  The dynamic and static modification of the
  epigenome by hormones A role in the
  developmental origin of hormone related cancers.
  Biochem Biophys Acta. Apr 20091795(2)104-109.
• Gerhard I, Waibel S, Daniel V, Runnebaum B.
  Impact of heavy metals on hormonal and
  immunological factors in women with repeated
  miscarriages. Hum Reprod Update. May-Jun
  19984(3)301-309

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Laboratory studies

• The ideal system of measurement of biological
  processes thus should examine the metabolic
  products of hormonal management of cellular
  activity
• Thus, the ideal laboratory system must
• Reflect the complex, integrated and dynamic
  nature of biological systems
• Describe the functionality of the system in its
• Qualitative function
• Quantitative function
• Individual unit, relative to other units and as a
  whole
• Assess the organism at the metabolic and
  interstitial level

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Biology of functions

• The Biology of Functions (BoF) quantifies
  functional abilities of the organism, before and
  after the effects of adaptation to stressors.
  Because functionality is dynamic, a dynamic,
  integrated and evolutionary methodology must be
  used instead of static lab values
• BoF is based on a number of specific indices
  defined by mathematical relations between
  commonly used blood analysis data
• The algorithms that permit the calculation of
  these indices are based on the physiological
  relations that exist between the direct or
  indirect products of hormonal activity cells,
  hormones or enzymes (eosinophils, TSH and LDH,
  for example).

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Biology of Functions

• These relations allow one to visualize the
  functioning of the organism at every level
  maintenance of homeostasis, adaptation, recovery
  after aggression, immunity, etc.
• Each function is quantified by an index,
  specified by a level of activity. The index
  expresses the actual activity of that function,
  both in and of itself and in relation to the
  metabolic and tissue needs of the organism.
• The whole set of indices gives an evolutionary
  assessment of an individual bodys functionality,
  system by system, organ by organ.

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Biology of functions

• SUMMARY Biology of Functions
• Allows one to determine
• Pathogenic tendencies of the organism
• The stage of development and the degree of
  severity of a potential pathology (i.e. cancer,
  cardiac disease, degenerative neurological
  disease)
• Can be used as a tool to track
• the natural development of pathology
• To derive a rational therapeutic treatment
• To evaluate the efficacy of the treatment over
  time

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Polycystic ovarian syndrome (PCOS)

• An Endobiogenic Approach

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Beyond binary relationships

• PCOS is a good example of how allopathic medicine
  is beginning to realize the importance of the
  qualitative relationship of hormones rather than
  quantitative ones in and of themselves. The
  following ratios have been found to be helpful in
  diagnosing PCOS
• Estradiol to Dihydro-testosterone ratio (Endocr
  Regul. 2008 Mar42(1)13-6)
• Glucose to Insulin ratio lt4.5 (Endocrinol Metab
  Clin North Am. 1999 Jun 28(2)397-408, vii.)
• LH to FSH ratio gt3 (Endocrinol Metab Clin North
  Am. 1997 Dec 26(4)893-912.)

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Where to proceed?

• Despite a growing recognition that the binary
  nature of laboratory evaluations in not
  sufficient to understand the spectrum of disease
  expression, Allopathic medicine lacks an
  integrated assessment of ontology, etiology and
  treatment of physiological derangements
• Case in point Standard of care for PCOS is to
  treat each endocrino-metabolic derangement
  separately from each other without considering
  their inter-relationship
• There is no explanation for why only 50 of PCOS
  patients are obese or why serum hormone levels
  may be normal despite physical exam findings
  suggesting otherwise, or why polycystic ovaries
  are not a sine qua non of PCOS

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Reductionistic treatment plan

• The allopathic treatment of PCOS consists of a
  piecemeal approach to inhibiting individual
  hormones with no concern for how it may affect
  the global functioning of the organism in its
  anabolic and catabolic activity
• Hirsutism spironolactone , oral contraceptives 1
• Menstrual irregularities Oral contraceptives ,
  metformin,pioglitazone, spironolactone
• Hyperglycemia, Hyperinsulinemia Metformin
  pioglitazone
• Infertility clomiphene, letrozol, metformin,
  pioglitazone
• 1. Drug treatments for polycystic ovary syndrome.
  Radosh L . American Family Physician, April 15,
  2009

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Endobiogenic approach

• The Endobiogenic approach considers the
  ontological role of all these endocrino-metabolic
  and tissular derangements as being linked to the
  bodys management of a fundamental structural or
  functional problem
• Prolactin can be elevated during chronic stress
• Hyperestrogenism is often an attempt to overcome
  Prolactins suppression of LH secretion of
  progesterone for ovulation

37
Endobiogenic approach

• Hyperandrogenism caused by DHEA from the adrenal
  gland, which is over-stimulated due to the stress
  state, and by testosterone from the ovaries due
  to LH excess, insulin excess, and/or increased
  theca cell enzyme activity.1
• Hypercholesterolemia with low HDL cholesterol
  Cholesterol is the source of all sex hormones and
  corticosteroids, which are needed to make more
  and more testosterone, estrogen and progesterone.
  HDL removes cholesterol from tissues which would
  be counterproductive to the demand of the
  tissues for more cholesterol.
• Hyperglycemia and hyperinsulinism reflect an
  attempt to meet the huge anabolic demands of the
  body with an appropriate amount of short term
  energy substrate
• The biochemical basis for increased testosterone
  production in theca cells propagated from
  patients with polycystic ovary syndrome
• Nelson VL, Qin KN, Rosenfield RL, Wood JR,
  Penning TM, Legro RS, Strauss JF 3rd, McAllister
  JM. J Clin Endocrinol Metab. 2001
  Dec86(12)5925-33.

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Biology of functions (BoF)

• Endobiogenic approach to PCOS involves
  understanding the totality of endocrinologic,
  neurologic and metabolic disturbances in
  relationship to each other.
• A few examples of the 157 indices of the biology
  of functions are discussed as relevant to PCOS
• When interpreting the BoF, the endocrine system
  is understood in its
• classical vertical activity (i.e. CRH?ACTH?
  Cortisol),
• horizontal activity (i.e. Dopamine? CRH? TRH?
  Prolactin), and
• radial activity (i.e. TRH? Prolactin? Insulin
  Estrogen Cortisol? Luteinizing Hormone)

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Categories of BoF

• Hypothalamic and pituitary level assessment of
  responsiveness to stimulation and feedback
• ?-MSH/a-MSH
• FSH 1 index
• LH 1 index
• Index of Estrogen-Somatotropic axis

40
Biology of functions

• Role of Adrenals vs. Gonads in producing
  androgens (Androgenic index)
• Efficiency of FSH and LH in producing estrogens
  and androgens, respectively (Gonadotropic index)
• Anabolic activity of estrogen (Quantative
  organo-tissular estrogen yield index)
• Progesterone activity (Progesterone index)

41
Biology of Functions

• The role of the Hypothalamic-Pituitary-Adrenal
  axis can be examined in various ways to
  understand the role of each endocrine gland in
  adaptive and maladaptive responses to stress
• Circulating Cortisol Index
• Aromatization of Estrogen Index
• Adrenal cortex index

42
Biology of Functions

• Role of the Somatotropic axis in general
  adaptation, maladaptation, and metabolic
  derangements can also be examined
• Prolactin index
• Insulin index
• Insulin resistance index
• Growth Hormone (GH) growth score
• Somatostatin index

43
Biology of Functions

• Psychological factors contributing to stress can
  also be quantified
• Global mental activity Ketonic index
• Internal dialogue Adaptogenic index
• Emotional etiology of stress response Thyroid
  relaunching index adjusted

44
Clinical phytotherapy

• Endobiogeny has developed a rational system of
  clinical phytotherapy based on clinical studies,
  empirical observations and traditional herbalism
• Elevated Prolactin Strawberry leaf (Fragaria
  vesca) mother tincture reduces pituitary and
  adrenal stress response through reduction of
  ACTH, TSH and Prolactin and aromatization of
  Adrenal androgens to estrogen
• Elevated Androgens-Estrogen ratio hops (Humulus
  lupulus) has estrogenic activity and inhibits LH,
  reducing total gonadal androgens1
• 1) Milligan SR, Kalita JC, Pocock V, et al. The
  endocrine activities of 8-prenylnaringenin and
  related hop (Humulus lupulus L.) flavonoids. J
  Clin Endocrinol Metab. Dec 200085(12)4912-4915.

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Clinical phytotherapy

• Clinical phytotherapy (cont.)
• Estrogen activity Chaste tree (Vitex agnus
  castus) is highly efficacious in its ability to
  alter receptor sensitivity to estrogen and
  modulate prolactin activity allowing for
  increased progesterone activity, restoring
  prospects for fertility1,2
• Insulin Resistance Wolfberry (Lycium barbarum)
  as a fluid extract or bulk herb reduces insulin
  resistance3
• Liu J, Burdette JE, Sun Y, et al. Isolation of
  linoleic acid as an estrogenic compound from the
  fruits of Vitex agnus-castus L. (chaste-berry).
  Phytomedicine. Jan 200411(1)18-23.
• Loch EG, Selle H, Boblitz N. Treatment of
  premenstrual syndrome with a phytopharmaceutical
  formulation containing Vitex agnus castus. J
  Womens Health Gend Based Med. Apr
  20009(3)315-320.
• Zhao R, Li Q, Xiao B. Effect of Lycium barbarum
  polysaccharide on the improvement of insulin
  resistance in NIDDM rats. Yakugaku Zasshi. Dec
  2005125(12)981-988.

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Other treatments

• Nutritional support
• Omegas 3 and 6 (cell wall stability, decreased
  inflammation, improved gonadotropic activity1)
• Magnesium and Calcium (noradrenaline,
  acetylcholine production, activity and recycling)
• B complex (management of stress)
• Diet low in inflammatory foods such as refined
  flours and sugar to reduce insulin secretion and
  insulin resistance, androgen activity2
• Stress relief cognitive behavioral therapy,
  meditation, yoga, massage therapy, acupuncture
• 1) Sidani M, Campbell J. Gynecology select
  topics. Prim Care. Jun 200229(2)297-321, vi 2)
  Smith R, Mann N, Makelainen H, Roper J, Braue A,
  Varigos G. A pilot study to determine the
  short-term effects of a low glycemic load diet on
  hormonal markers of acne a nonrandomized,
  parallel, controlled feeding trial. Mol Nutr Food
  Res. Jun 200852(6)718-726.

47
Conclusions
48
Conclusions

• Endobiogeny is the study of the internal milieu
  of the organism within itself and in its
  relationship with its environment, stressors,
  etc. from the standpoint of the endocrine system
  as the manager of human life
• It combines in an integrative understanding
• a philosophical consideration of the ontology of
  structures and functions of the body,
• a rational approach to understanding physiology
• an empirical assessment of history and symptoms
• utilization of a dynamic, integrative and
  integrated metabolic assessment of endocrine
  management of the organism called the Biology of
  Functions
• an integrated assessment of all clinical data to
  obtain a precise understanding of maladaptive
  physiology
• In order to create a rational, individualized
  treatment plan

49
Conclusions

• The Biology of Functions is an algorithmic
  assessment of the qualitative and quantitative
  relationships of hormones in terms of metabolic
  activity from nuclear, cellular, tissue, organ
  and system-wide perspectives
• The Biology of Functions allows for an objective,
  longitudinal assessment of the effects of therapy
  over time
• Endobiogeny relies on phytotherapy, oligotherapy,
  and diet as well as lifestyle modification as its
  preferred methods of ameliorating physiological
  imbalances
• It reserves the use of synthetic drugs for urgent
  cases, or when the body is not able to establish
  an equilibrium by the effects of functional
  regulation

50
Resources

• To learn more about Endobiogeny
• Web
• Genearal information
• www.endobiogeny.com
• Biology of Functions demonstration
• http//extranet.endobiogenics.com/en/

51
Contact

• Kamyar M. Hedayat, MD, President, American
  Society for Endobiogenic Medicine and Integrative
  Physiology
• Contact president_at_endobiogeny.com
• Web www.endobiogeny.com