An Integrative and Functional Medicine Approach to Vulvar

An Introduction to Integrative
and Functional Medicine
? Vulvar Disorders ?
Rebecca A. Malamed M.D.
Integrative and Functional Medicine
Pain Management
What is Integrative and Functional
• Integrative medicine
Healing- oriented medicine
Focus on therapeutic relationship
Whole person (body, mind, and spirit)
All appropriate therapies, both conventional and
• Functional medicine
– Dysfunctions of physiology and biochemistry
– Chronic disease assessment, prevention and Rx
Differences in Diagnostic Approaches
• Conventional Medicine:
– Disease/disorder based diagnosis
– Vulvovaginitis, Vulvodynia, Lichens Scleroris, Lichen Planus,
Hyperplasia, Neoplasia
– Search for “magic bullet” as Rx
• Integrative/Functional Medicine:
– All symptoms in ANY system relevant
– “Anything can cause anything”
– Search for underlying function to Rx
– Functional Medicine testing
Differences in Treatment Approach
• Conventional medicine
– “Evidence-based”
– Gold Standard: double-blind placebo-controlled
– Pharmaceutical/intervention driven Rx
Integrative/Functional medicine
– Basic research-based
– Gold Standard: Individual patient symptom resolution
– Least harmful/synergistic Rx to allow body to heal
Your Genes on Twinkies
• Environment and Gene Expression account for
almost all human disease (Epigenetics)
• Disease vs. Health is an expression of each patients:
– Genetic predisposition: Cofactors, Detoxification, Immunity
– Physical Environment: Nutrition, toxins (heavy metals,
fungus, sucrose/fructose), sleep, exercise
– Emotional milieu: Family, friends, mental health
– Spiritual beliefs and practices
The 7 Organizing Systems Where
Clinical Imbalances Develop
• Assimilation: Digestion, absorption, microbiota/gi, respiration
• Defense and Repair: Immune, inflammation, infection/microbiota
• Energy: Energy regulation, mitochondrial function
• Biotransformation and Elimination: Toxicity, detoxification
• Transport: Cardiovascular, lymphatic system
• Communication: Endocrine, neurotransmitters, immune messengers
• Structural Integrity: From subcellular membranes to musculoskeletal
• Complete and healthy absorption requires
– Intact intestinal villi
• Food Sensitivities can damage and destroy
intestinal villi
– Mediated through IgA Immediate Type
Hypersensitivity Reactions
Destruction of Intestinal Villi in Celiac
• Absorption
– Increased intestinal permeability can lead to
symptoms or signs of ANY inflammatory condition
locally or systemically
– Mediated through IgG delayed type
Leaky Gut Progression
• Microbiome: 100 trillion bacteria
– Skin, gut, mouth, vagina
• Local antimicrobial treatment not sufficient?
– Healthy microbiome (balanced flora)
– Dysbiosis (opportunistic species predominate)
– Vulvar-vaginosis, vulvodynia and other vulvar
disorders may have abnormal GI flora as precursor
Defense and Repair
• Decreased Immunity
– Host defense vs. virulence of organism
– Vulvar-vaginosis, Vulvodynia
• Excessive Immunity = Inflammation
– Food sensitivities (IgG, IgA), Toxins
– Autoimmunity
– Vulvodynia, Lichens Scleroris, Lichen Planus,
Hyperplasia, Neoplasia
Biotransformation and Elimination
• We are what we eat? Actually…
• Want cleanest in and dirtiest out
• Limit toxicity and need for detoxification
• Vulvovaginal disorders may be caused by an
accumulation of inflammatory mediators locally
and total body burden of toxins
• Natural: Plants and microbes
• Manmade: Chemical, heavy metals etc.
60,000 to 80,000 in common use
$1.5 trillion in 2010 sales by Census Bureau
Backlog of 10,000 never tested by EPA
US largest manufacturing sector
The Liver Detox Pathways and
Essential Nutrients
Diet recommendations
• Organic/Biodynamic
• Non-GMO
- Corn, soybeans, canola, papaya, sugar beets
• Avoid processed food
- Pesticides, dyes, additives
• Candida diet
- Low glycemic, non-fermented (no alcohol, soy sauce)
• Cook and store food with stainless/glass
Elimination Diet for Food Sensitivities
• Most Common
- Eggs, dairy, gluten, corn, soy
• Nightshades (Solanine)
- Potatoes, eggplant, peppers , tomatoes
• Methylxanthines
- Chocolate, coffee, caffeinated tea
• Any food cravings
Rx Toxins/Irritants
• Chlorine
– Filtered water (drinking/bathing)
– Organic cotton underwear
• Hygiene products
– Organic tampons, non-toxic soaps etc.
– Environmental working group (EWG)
• Heavy metals
Mercury: amalgams, predatory fish
Lead: solder in water pipes, paint, leaded gasoline
Aluminum: cookware, antiperspirant
Mineral Cosmetics, Gadolinium contrast dye
Natural Detoxification
• Diet
– Dark leafy greens,
garlic, onions,
vegetables, seaweed
• Fiber
- Organic oat bran,
charcoal, bentonite
• Deep Breathing
- Exercise, meditation
• Sweating
– Hot baths, saunas
(infrared), exercise
• Supplements
- Glutathione, vitamin
E, glycine, taurine,
NAC etc.
Goals of Natural Antimicrobials, Immune
Modulators and Detoxification
• Increase innate host resistance and immunity
• Downregulation of excessive inflammation
• Balancing of microbiome synergistically
• Prevention of microbial resistance
Natural Antimicrobials
• Prebiotics/Probiotics
Inulin, fermented vegetables
– Multiple probiotic strains
• Coconut oil
(MCFA, Lauric acid, Caprylic acid)
• Essential oils
Tea Tree, Lavender, Oregano
• Herbs/Barks/Mushrooms
Pau D’Arco, Berberine, Sweet Wormwood, Reishi
Natural Anti-inflammatories
• Omega-3 & Omega-6 Essential Fatty Acids
Grass fed beef/lamb/dairy (omega-3)
Organic nuts and seeds (omega-6)
Fish oil (omega-3)
Blackcurrant seed oil (GLA,)
Sesame seed oil (omega-6)
• Antioxidants
– Dark green leafy vegetables, cruciferous vegetables
– Turmeric (curcumin), Red grapes (Resveratrol)
• Our genes + our environment = our health
• “Anything can cause anything”
• Goals:
– Increase host immunity and defense
– Decrease (modulate) inflammation appropriately
• Method:
– Removing environmental stressors
– Optimizing underlying biochemistry
– Offer synergistic support of body systems
More Information
• Related articles @
Dysbiosis - a gut reaction
Food sensitivities and allergies
Sugar - not so sweet after all
Heavy metals
Detoxification - an essential process
Acute and chronic inflammation - more than just a pain
A balanced diet - why’s it so complicated?
Genetically modified food - what’s for dinner?
Probiotics in prebiotic
Dietary fiber - the lost nutrient
Rebecca A. Malamed MD
10780 Santa Monica Blvd. #480, Los Angeles CA 90025
310-474-8111 / [email protected]

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