Category Archives: Integrative Medicine

Parker Seminars Hosts NeuroCon 2022

NeuroCon Keynote Speakers

Dallas, Texas, July 18, 2022 (GLOBE NEWSWIRE) -- From July 29-30, 2022, join Parker Seminars for an exciting in-person, two-day event designed specifically for healthcare professionals! Attendees will learn from and network with well-known worldwide leaders who specialize in disorders of the nervous system. Sessions are centered around a superior integrative approach to supporting research and application for treating neurological disorders.

Taking place on the Parker University campus in Dallas, Texas, attendees will hear from industry experts and speakers, earn CE hours, and network with each other and exhibitors.

Parker Seminars is excited to announce that its keynote speakers include Max Lugavere (New York TimesBest-Selling Author and host of the No.1 iTunes Health Podcast, The Genius Life),Kimberly Noble (Professor of Neuroscience and Education at Teachers College Columbia University),Tali Sharot (Neuroscientist and Professor of Cognitive Neuroscience at University College London and MIT), andOctavio Choi (Board-certified Forensic Neuropsychiatrist and Clinical Associate Professor in the Psychiatry Department at Stanford University School of Medicine).

NeuroCon 2022 will provide attendees with the expertise needed to equip themselves and their patients with the most relevant knowledge for maximizing the brains potential. To learn more or sign up, visitneurocon.parkerseminars.com.

About Parker University

Parker University, the fourth-fastest growing college in Texas and the fastest-growing college in Dallas, was founded in 1982 by Dr. James William Parker (formerly Parker College of Chiropractic). Today, Parker University has more than 1,800 students and more than 35 academic programs,including its famed chiropractic program, as well as masters degrees in neuroscience, clinical neuroscience, strength and human performance, and functional nutrition. Currently, Parker Universitys chiropractic cohort is the second largest of any campus in the world.Parker University has been recognized as a Great College to Work For, one of the 25 Fastest-Growing Colleges in the U.S.,and as a recipient of the 2021 FutureEdge 50 Awards.

Story continues

Attachment

Read the rest here:
Parker Seminars to Host NeuroCon 2022 Event on Parker University Campus July 29-30 - Yahoo Finance

Introduction

Galactose--1,3-galactose (-Gal), an oligosaccharide that structurally resembles blood group B antigen, is present in both glycoproteins and glycolipids from non-catarrhine mammalian muscle cells and secretions.1,2 Old World monkeys, apes and humans evolved with the inability to synthesize -Gal epitopes and, therefore, produce natural anti--Gal antibodies to control pathogen infection.3 This carbohydrate epitope is the causal agent of the -Gal syndrome (AGS), a pathognomonic immunoglobulin E (IgE)-mediated delayed anaphylaxis in mammalian meat (eg pork, beef or lamb) or dairy products 3 to 6 hours post-consumption.47 Recently, an allergic cross reaction to flounder roe in patients suffering from AGS has been reported.8 The other clinical presentations of AGS comprise immediate hypersensitivity to -Gal-containing drugs, firstly discovered using the monoclonal antibody cetuximab in anticancer therapy.6,9 There is growing evidence of allergic reactions caused by the -Gal present in mammalian substances such as gelatin, glycerin, lactic acid and magnesium stearate used in the preparation process of several medications,9,10 such as gelatin-containing products (vaccines and volume colloids), mammalian serum-based antivenom and even various analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs).2,6,11,12 The IgE initial sensitization is caused by hard-bodied tick bites from different species according to geographic location and is attributed to -Gal-containing tick salivary glycoproteins, but also other tick salivary biomolecules without -Gal modifications such as prostaglandin E2 (PGE2).1317 The mechanisms behind tick -Gal induction of sensitization are still unknown, but besides the -Gal moiety, tick sialome components may play an important role in the chained immune reaction activation (Figure 1).18,19 Tick species such as Ixodes ricinus in Europe, Amblyomma americanum in North America, Haemaphysalis longicornis in Asia and Ixodes holocyclus in Australia are linked to AGS,20 currently considered an emergent life-threatening allergy in tick endemic areas worldwide.2123 However, not all individuals bitten by ticks or those that carry elevated specific IgE (sIgE) against -Gal develop AGS, in fact, the majority only produce sIgE against it.19 Symptomatic individuals typically show delayed pruritus, urticaria (acute or recurrent), angioedema, anaphylaxis, malaise or gut-related symptoms such as abdominal pain, vomits and diarrhea.22,24,25 Anaphylaxis has been triggered in up to 60% of AGS cases and can be fatal if it is not treated promptly.2628 Clinical features reported tend to be restricted to gastrointestinal complaints, hampering the suspicion of an allergic etiology.29 Nevertheless, clinical observations in AGS patients are widely variable, showing proof of individual sensitivity.5 Augmenting factors, also called cofactors, such as exercise and alcohol intake, have been reported to play an important role in modulation of this individual susceptibility between patients.30 The medical history is of importance in these cases and details like meat-associated delayed allergic reactions and tick bite-exposure represent crucial factors for uncovering AGS, which otherwise can be misdiagnosed as idiopathic anaphylaxis or chronic spontaneous angioedema.7,30,31 Risk factors for developing sIgE to -Gal are related to the probability of individual tick bite-exposure in certain environmental conditions, including practice of outdoor activities (eg, hunting or hiking), living in rural areas, pet-ownership, and certain jobs such as forest service employees.3235 The sIgE values tend to increase according to the number of tick bites per year and on how recent those bites are.34,36 Moreover, individuals that do not have type B or AB blood group may have a higher risk of developing AGS, as blood group B antigen, similar to -Gal, creates tolerance to this epitope.37

Figure 1 Alpha-Gal syndrome (AGS). (A) Sensitization after several tick bites. Tick saliva contains glycoproteins, glycolipids with -Gal epitopes and other unknown salivary biomolecules that could be involved in the pathology of AGS. The glycan -Gal is presented to T helper 2 (Th2) cells through antigen-presenting cells (APCs) as dendritic cells, macrophages or even B cells. Once T cells are activated, B cells are leading to produce IgE against -Gal (anti -Gal-IgE) in an enriched interleukin environment and potentiate IgE production in plasma cells. Free IgE are now available to interact and bind to IgE receptors present in basophils and mast cells. (B) Allergic Reaction. When AGS patients ingest mammalian meat containing -Gal bound to proteins or lipids, these molecules expressing the allergen epitope are absorbed and incorporated to lipid/protein macromolecules during digestion (chylomicrons, lipoproteins), which will be processed and transport through protein or lipid metabolism to systemic circulation and peripheral tissues. About 36 hours post-consumption, IgE-mediated and coated effectors will recognize the allergen, leading to degranulation of basophils and mast cells and promoting a systemic delayed allergic reaction. AGS can also comprise an immediate anaphylactic reaction, triggered using -Gal containing drugs, administered via parenteral due to therapeutic reasons.

On the other hand, immune response to -Gal has been studied for the control and prevention of diseases, exhibiting a protective role in human evolution catastrophic selection. The incidence of several infectious diseases caused by -Gal containing-pathogens such as malaria or tuberculosis might be positively correlated with the frequency of the specific blood type B, and then, with a reduced immune response to -Gal. However, this fact has been associated with a lower prevalence of food allergies related to anti--Gal IgE antibodies.38 In addition, it has been recently reported a positive correlation between anti--Gal IgM antibodies and the incidence of Plasmodium falciparum infection, decreasing its transmission.39 Despite the fact that uncontrolled levels of anti--Gal antibodies could compromise health in AGS patients, these findings suggest that anti--Gal antibodies (IgE or IgM) might protect against parasites containing -Gal on their surface. Interestingly, anti--Gal antibodies have also been studied not only in vector-borne diseases but also in emerging virus infections. Recently, it has been reported that anti--Gal antibody levels negatively correlate not only with SARS-CoV-2 infection but also with COVID-19 symptomatology severity.40

Over 10 years have passed since the discovery of AGS,41 but many questions remain unclear that still need to be elucidated, especially those related to the diagnostic and therapeutical approaches used for this syndrome. The aim of the present review article is to outline current diagnostic methods used for AGS and potentially future diagnostic tools, combined with the most recent forms of treatment/management of this syndrome. Furthermore, innovative topics such as current research methods and future treatment and preventive strategies are also discussed.

The AGS is an allergic disorder that challenges clinical diagnosis due to inapparent presentation and delayed reactions.19,42 Like any other allergic disease, diagnosis relies on a well-detailed medical history in order to reach an accurate evaluation and prognostic of individual signs and symptoms.25 Diagnostic techniques for this syndrome are not specific and/or represent a risk for the patients health, whereas more precise methods still show limitations to its use.43 As discussed here, it is important to address the diagnostic tests more commonly used and methods that could potentially be employed in the future (Figure 2) for the challenging and complex allergy that involves the pathology of AGS.

Figure 2 Conventional and next generation methods for the diagnosis of the alpha-Gal syndrome (AGS).

SPTs remains a useful diagnostic tool for several food allergies.44 Conversely, conducting this test for AGS diagnosis using conventional and commercially available mammalian meat extracts (beef, pork or lamb) lacks sensitivity, yielding low-reactive results (24 mm wheals), which may lead to misdiagnosis and incorrect patient management.45 Alternatively, cancer drug cetuximab can potentially be used as a sensitivity agent due to its high capacity to induce a strong skin reactivity in AGS patients, mainly caused by the larger amount of -Gal epitopes exposed to the surface.46,47 Robust reactions also occur when mammalian meat extract is used, although this is not a feasible option for daily practice.16 Meat-derived gelatin from porcine or bovine, sometimes forming colloids, has also been used in allergic reaction diagnostics. Furthermore, it is important to consider that, although rare, the use of high-sensitivity components in SPT could potentially trigger a fatal anaphylactic shock reaction.48,49 Less commonly, intradermal testing (IDT) can also be used as a standardized methodology to evaluate skin reactions. As described by the SPT method, 20 minutes after allergen intradermal injection (around 0.1 mg/mL), swelling, redness and wheals are observed in the area of injection.50 Nevertheless, IDT is more likely to induce systemic anaphylactic reactions when compared to SPT.44 Overall, the clinical utility of SPT remains doubtful as no food allergen fits flawlessly in this diagnostic technique, conveying on several limitations and therefore making it not fit for a primary approach diagnostic tool.

For the diagnosis of a food allergy (FA), OFC is the gold standard technique, offering further information regarding food tolerability and threshold of responsiveness.51 This method could be useful for discriminating AGS diagnosis from -Gal sensitization if it did not convey to a risk of fatal or near-fatal delayed anaphylactic reactions.7,52 Therefore, this challenge can only be performed in specialized allergic centers, requiring long patient observation periods.7,53 Besides risk, OFC is not established as a standardized procedure for AGS and exposure reaction presents a high variability between patients. In fact, some patients may require the presence of cofactors in order to react, while others only respond to a particular type of red meat.54 Nevertheless, this method, tested also in combination with cofactors, is essential in patients in which drugs-containing -Gal must be given for therapeutical reasons due to the clinically relevant information that it provides.55 Cofactors, such as acetylsalicylic acid (ASA) or alcohol, are well-known amplifiers of -Gal reactions.6 Due to the wide difference between symptomatology of AGS patients, sensitivity to -Gal can be truly variable.30 However, it has been observed that pork kidney intake, and no other product like muscle meat, even in the coadministration of cofactors, is a key element to raise AGS symptoms. This difference might be explained due to the higher number of -Gal epitopes present in pork or beef kidney in comparison to other meats/innards.56,57

Currently, serum anti-Gal IgE levels measured using an immune-enzymatic assay (bovine thyroglobulin-conjugated ImmunoCAP) is the confirmatory diagnostic method used for AGS diagnosis when medical history matches with this disease.5860 Nonetheless, it remains unclear the clinical relevance of positive testing for anti-Gal IgE using a cut-off value of 0.35 kU/L (where 1 kU/L = 1 IU/mL = 2.4 ng/mL).33,42,46,52,61 While Mabelane et al54 state that 5.5 kU/L is the cut-off point for clinically significant AGS, other studies reveal that there are no strict criteria regarding anti-Gal IgE levels as an allergic symptomatology predictor.25,62 One thing is clear, though, is that levels of specific IgE are not a useful biomarker for predicting the severity of allergic reactions, as AGS patients experiencing anaphylactic reactions may maintain IgE levels overtime or even in rare occasions with anti-Gal IgE negative results.25,63 Another issue with the anti-Gal IgE diagnostic assay is that it can lead to false-positive results in those individuals where Gal IgE sensitization may also be related to bee and wasp stings, parasitism, atopy or cat ownership, creating cases where these antibodies do not match the clinically pathognomonic history of AGS.25,42,62,64,65 For example, in a clinical study carried out in southern Germany, among 300 hunters with a 19.3% of IgE--Gal prevalence (58 individuals positive for cut-off value of 0.35 IU/mL), only 1.67% (5 individuals of the initial cohort) had allergic reactions to mammalian meat.33 Moreover, serum levels of IgE to Gal tend to drop when patients do not experience recurrent tick bites, but again, the rate of declination between individuals is widely variable, being therefore recommended to repeat testing every 8 to 12 months.25,45 Nevertheless, due to AGS non-related therapeutical reasons, sometimes the measurement of anti-Gal IgE levels may be needed to detect Gal sensitization and therefore prevent drug-induced anaphylaxis.60 In summary, anti-Gal IgE levels may be useful for AGS diagnosis, but clinical symptomatology and disease severity cannot be evaluated exclusively through this parameter, requiring complementation with other diagnostic techniques.

Over the years, research studies allowed to recognize distinct improved biomarkers that provide a more accurate diagnosis of food allergies.66 This led the way to the use of the in vitro functional assay BAT, a flow-cytometry-based technique that quantifies the expression of activation membrane markers, namely, CD63 and CD203c, in order to analyze basophil degranulation when triggered by a specific allergen.6668 In the research setting and specialized referral centers, BAT is being used as a diagnostic clarifier, allowing to distinguish between merely asymptomatic sensitized individuals and patients suffering from AGS.42,53,69 This newly emerging method offers good sensitivity and specificity, but presents several practical and logistical issues for implementation in clinical practice.43,70 First, blood must be processed within 24 hours after being collected in order to guarantee that basophil viability and reactivity are preserved.6,71 Second, questions regarding reproducibility and cost must be addressed before BAT implementation in practicing allergists.72 Unfortunately, methodology, concentration and markers are not standardized between laboratories in order to allow result comparison and test validation.73 Furthermore, standardization between systems and instruments required for accreditation (eg, EuroFlow Standard Operating Procedures) is missing, reducing BAT availability.74,75 This technique also lacks an established proficiency testing by regulatory entities. The current European Directive 98/79/EC on in vitro diagnostic medical devices76 will be replaced in 2022 by the new Regulation (EU) 2017/746 and introduce major changes in the sector, aiming for a smooth functioning of the internal market.77 In sum, efforts should be made to convey on transforming BAT into an on-hand tool for clinicians, due to the benefits it presents on risk allergy stratification, precise decision-making for -Gal sensitized patients who lack medical evidence and selection of the correct doses for OFC in AGS-suffering individuals.53,72

Another in vitro assay executed by flow cytometry is the MAT, a technique that measures CD63, a membrane activation marker that increases when mast cells (MCs) degranulate. This phenomenon occurs when MCs are triggered by allergen-sIgE antibodies.66,78 MAT presents high sensitivity and leads to a dose-dependent response to allergens,79 making it a potential and attractive complementary candidate for AGS diagnosis. Furthermore, MAT seems to overcome BATs major limitations. First, the use of MCs rather than basophils appears to be more suitable for allergy diagnosis due to the well-recognized effector function of MCs in comparison to the mere regulatory activity of basophils.80 Secondly, serum samples can be frozen prior to their use, as MAT does not require fresh viable cells, facilitating logistics and sample shipment if required.81 The MCs line can be activated directly through mas-related G protein-coupled receptor X2 (MGPRX2) with simultaneous analysis of positive and negative populations for this receptor. Herein, MC degranulation can be studied via upregulation of specific degranulation markers, such as CD63. Most common MRGPRX2-expressing cell lines used in combination with CD63 detection by flow cytometry are LAD-2 cells derived from human CD34+ cells.82,83 However, there is still a long way to go from standardization to validation to obtain a fully functional MAT assay, as currently this technique is particularly time-consuming and several key issues still persist regarding heterogeneity of MCs.70,84 Although MAT test is still under validation for clinical application, it represents a promising diagnostic approach, particularly as a confirmatory test when conventional methods generate ambiguous results.66,82

Another emerging diagnostic test in the FA field is the HR assay, a standardized test based on fluorescence intensity that measures the amount of histamine released by activated basophils.85 Although even further studies are required to support standard results, this technique could potentially be used for AGS diagnosis since basophil reactivity was found to be higher in these patients when compared to -Gal sensitized individuals.10 Indeed, this method displays similar high sensitivity and specificity values when compared to the BAT test,86 but further studies are required to support this result, especially involving AGS-suffering patients.

Collective characterization and quantitation of biomolecules known as omics technologies such as metabolomics, metagenomics, proteomics and transcriptomics could advance knowledge of the immune response in AGS and its molecular drivers, enabling the identification of biotargets for molecular diagnosis of this global impact disease.10,87 Not only the identification of host biomarkers and host-derived immune response mechanisms but also tick-derived biomolecules are important for the development of new diagnostic tools.52 Proteins present in tick sialome, especially highly conserved across tick species, could potentially serve as diagnostic antigens.47 A recent study by Villar et al88 identified by proteomics analysis of tick sialome and alphagalactome the 14-3-3 family chaperone that could possibly constitute a future diagnostic disease biomarker. The study identified that 14-3-3 family chaperone and other proteins were recognized by IgE in sera from AGS patients.88 Therefore, they proposed that these proteins may potentially be involved in the AGS and other disorders with the possibility of mediating protective immune mechanisms against tick infestations and pathogen infection.88 Nevertheless, there are also tick salivary gland proteins with non--Gal modifications that could probably be used to develop ELISA tests for antibody quantification as a complementary diagnostic method for AGS.47,52,89

Artificial intelligence (AI) and machine learning are considered to be powerful diagnostic assistance tools, which in the future could revolutionize the healthcare system providing an accurate and custom-based diagnosis.90 MBR algorithms aim to create a clinical diagnosis or decision-making model that utilize hybrid reasoning and data-driven AI in order to obtain high diagnostic yields by combining the integrative medicine concept.91 For puzzling and complex diseases, such as AGS, in which diagnostic tools lacking standardization and cofactors are also involved, the use of this integrative diagnostic technique could represent the best fitting method. The use of this methodology has been proposed by de la Fuente et al52 for improving AGS diagnosis, considering together clinical symptoms, risk factors and anti--Gal sIgE levels. They also proposed that the machine learning algorithm could be transformed into a code for a software creation with further implementation in clinical practice via mobile applications.52

Ticks are today the most accepted evidence for sensitization to -Gal, but other risk factors or co-factors are likely relevant.92 Daily diet counseling, tick bite avoidance or environmental education should be firstly considered in customizing an accurate treatment for the AGS.42,61 Subsequently, an expertise behind medical interventions is required for an adequate management of the disease over time.43 Although most cases are not emergency cases, invasive techniques are required for in shock patients treatment.6 Furthermore, established protocols, symptomatology, or information about the AGS characteristics are not available due to the wide natural history and variety of subjects all over the world. Herein we present some of the most common strategies and routinary methodology in AGS treatment/management when the disease is diagnosed.

The pillar of the non-medical approach is based on avoidance. The prevention of tick bites is relevant because continuous exposure to tick bites may maintain or increase anti--Gal IgE titers and lead to allergic responses to previously tolerated foods.92 Despite limited evidence, patients who successfully avoid tick bites on a long term (12 years) have a higher chance of recovering tolerance to meat products, allowing the reintroduction of red meat into diet.10,42,93 The most common strategy for tick-bite prevention and management includes the use of lighter colored protective clothes treated with insect repellents or insecticides such as permethrin.21 Furthermore, prompt embedded tick removal using specialized fine-tipped forceps should be performed in order to reduce the amount of secreted salivary allergens.24,92

Secondly, avoidance of mammalian meat, by-products of meat (innards), fat (gelatin and lards) and other -Gal-containing foods such as dairy products represent a crucial management strategy for AGS.10,92 To achieve this goal, dietary counseling is vital, and it can be combined with nutro clinical support to avoid nutritional deficiency, especially in highly sensitized individuals.6 Patients should receive a personalized dietary follow-up depending on which foods are allergy triggering and to routinely check for iron and vitamin B12 supplementation needs.21,61

Another major foundation for AGS management is education. Vulnerable patients should be taught on nutrition facts label reading, awareness of hidden exposures and be provided with a written plan on how to promptly operate in case of an allergic reaction.6,42,61 Clinicians must also inform patients of the risk of onset anaphylaxis not only due to cetuximab but also because of heparin, gelatin-containing vaccines and mammalian heart valves.94 The fact that numerous pharmaceutical products contain animal-derived excipients makes it harder to avoid all potentially immunogenic antigens.95 For this reason, it is recommended for AGS-suffering patients to wear warning bracelets about their condition so that physicians are aware and can prevent future life-threatening situations in emergency cases.61 In fact, due to the worldwide increase in individuals with high anti--Gal IgE titers and possibly undiagnosed AGS-patients, an allergy prescreening before administration of -Gal containing medication might be recommended.96

Due to the AGS delay and unexpected symptomatology, emergency treatment is of utmost importance to correctly manage allergic reactions and potentially life-threatening anaphylaxis.6 Furthermore, the high variability regarding severity and timing of the symptoms represents a challenge for the medical management of this disease.21 Intramuscular epinephrine administration represents the initial recommendation. For patients in shock, intravenous epinephrine should be applied alongside with fluid resuscitation and occasional vasopressors. In case of airway obstruction, intubation may be necessary.97 Afterwards, in order to properly reduce the risk of a multisystem allergic reaction, it is imperative to always carry an epinephrine auto-injector.21 For tick-bite local reactions, symptomatic treatment with oral antihistamines, corticosteroids and cold compresses should be enough to reduce non-serious symptoms such as pruritus, urticaria and angioedema.98 As AGS symptomatology and severity are reported to have high individual variability and rely mostly on symptomatic treatment, information collected mostly from case reports is presented in Table 1, together with their clinical management apart from the anaphylaxis acute treatment-response already discussed. A recent study described a clinical case with abnormal neuro-psychiatric behavior (abulia, aphasia, abnormal gait, and reduction of limb movement) related to AGS and a possible -Gal driven immune-related hypothalamic dysfunction that needs further investigation.99 Other symptomatology such as palpitations and tachycardia are self-limiting and therefore resolve spontaneously.100

Table 1 Drugs and Associated Pharmacological Class Used for -Gal Syndrome Medical Treatment

As described above, humans evolved as non-capable organisms to produce the glycan -Gal.114 Together with the fact that a wide variability exists between individuals suffering from this disease,5 AGS comprehension becomes a complex goal in which molecular and physiological mechanisms need to be elucidated. Several experimental model hosts are currently available for the study of AGS and the immune response to -Gal. Zebrafish (Danio rerio) model has been established and validated under laboratory conditions. This animal model was developed by Contreras et al,115 in which allergic hemorrhagic anaphylactic-type reactions together with behavior changes and mortality were observed in response to tick salivary compounds and mammalian meat consumption. The reactions were associated with tissue-specific toll-like-receptor-mediated responses in Th1 and Th2 helper cells. These data support the use of zebrafish as an animal model for the study of the AGS and bring a new perspective for future strategies in the control of infectious diseases as reported for tuberculosis using vaccination with -Gal.116

Murine models have been used for decades as validated experimental in vivo methodology for investigating both human and animal diseases due to the advantages that these models offer in terms of time, reproducibility and genetic characteristics.117,118 However, wild-type mice produce biologically active 1,3-galactosyltransferase (1,3GT) for the synthesis of -Gal and thus lack anti-Gal antibodies.119 Knocking out the 1,3GT gene results in the absence of -Gal epitopes, not only in murine models but also in pigs,120,121 thus becoming humanized experimental animal models.

The mice C57BL/6 line is one of the most common strains used in research.122 The humanized murine model of this strain for studying AGS (GTKO, AGKO or 1,3-GalT-KO), has been used for the study of tick-induced IgE response-model for -Gal reactions,123,124 but also for testing other immunological approaches as tick-borne allergies and Chagas disease investigation.125,126

Using these animal models, further research is needed to investigate AGS risk factors and epidemiology in order to propose an accurate treatment strategy for each patient.

Mammalian meat desensitization by oral immunotherapy (OIT) has been proposed as a promising treatment for AGS as it would improve patients welfare and safer management.127 It consists of daily intake of small and generally increasing amounts of allergen, in order to reduce the immune response and consequently produce own allergen desensitization.128 To date, there are only three successful case reports (two adults and one pediatric case) of AGS with oral desensitization to beef meat.127,129 Although this type of treatment leads to a sustained unresponsiveness,93 it requires an individual effort from the patient to consume daily 120 grams of cooked mammalian meat in order to maintain desensitization,129 which also becomes an obligation and can have an impact on the patients routine, commodity and mental wellbeing. Indeed, daily mammalian meat intake could compromise the patients to develop other metabolic and cardiometabolic diseases such as hypertension, diabetes and obesity.130,131 Additionally, allergen-specific immunotherapy (AIT) using natural and recombinant -Gal containing proteins from tick sialome is also being considered for AGS treatment.17 Nonetheless, this type of therapies comes with a risk of life-threatening anaphylactic adverse reactions and demand a thoughtful and balanced management of accurate dose efficacy versus side effect appearance.66,132

Given the potential risks associated with immunotherapy, the use of allergen non-specific treatments, such as anti-IgE therapeutic monoclonal antibodies (mAbs), has found application in the treatment of food allergy.133,134 In anti-IgE therapy, mAbs bind to free serum IgE and IgE-coated B cells, acting as a competitive substrate and reducing the availability and binding between these antibodies (natural IgE) and allergy mediators such as basophils and mast cells, which increases reaction threshold and consequently reduces the risk of mild and severe anaphylactic reactions (Figure 3).43,134 Combining anti-IgE therapy as a pre-treatment with immunotherapy techniques leads to a safer administration of OIT and allows to reach the maintenance dose more rapidly.128,133,135 The anti-IgE agent omalizumab has been sporadically used in specialized centers as monotherapy in AGS patients for successfully controlling continued reactivity, allowing the introduction of a small amount of mammalian meat in their diet.42 With such a positive preliminary outcome in these patients and promising data results in other FAs (peanut and cow milk), new clinical trials using biological therapies for AGS are needed, potentially representing a future effective treatment.42,43,133

Figure 3 Anti-IgE therapy. IgE-mediated reaction with release of histamine and other co-factors occurs due to interaction of allergen-specific IgE available with IgE receptor in mediator cells (basophils, eosinophils or mast cells), which are degranulated and increase the risk of life-threatening anaphylactic adverse reactions. The pharmacological and clinical aims of the use of anti-IgEs monoclonal antibodies (mAbs) as drugs is to downregulate and/or decrease IgE production by B cells. Anti-IgE antibodies bind to both IgE-expressing B cells and free serum IgE, markedly decreasing IgE levels available for binding to IgE receptor in allergic reaction-mediator cells and, consequently, gradually compromising mast cells and basophils sensitivity to allergens.

Management of FAs is becoming less generic and more target oriented.66 Consequently, there is still a need to improve our understanding of the immunological mechanisms behind tick bite sensitization and therefore identify new and more specific targets for the development of new treatment interventions for AGS.136

Prevention from developing AGS stands on avoiding the initial -Gal sensitization caused by tick bites, being particularly beneficial for at-risk population.21,35,36 Apart from the common strategies for tick-bite prevention mentioned above, the development of tick-antigen-based vaccines could not only protect against AGS but also against other tick-borne diseases.14

Therefore, to follow the vaccinomics approach, it is essential to identify tick bioactive molecules and consequent signaling pathways that mediate tick-host-pathogen interactions.137,138 For example, in a study by Mateos-Hernndez et al,47 tick sialome proteins, with or without -Gal modifications, that led to a protective immune response and were recognized by AGS patients but not control individuals could serve as potential target antigen candidates for vaccine development. The identification of the poorly understood molecular mechanisms behind the development of spontaneous acquired tick resistance (ATR) is also of key importance as it could help in the search for new vaccine formulations.139 Discovering which tick salivary antigens are natural targets of ATR will help to aim towards the inhibition of tick feeding, reproduction and further pathogen transmission.140

AGS is an atypical, underdiagnosed vector-borne allergy that presents clinical implications beyond expected due to the presence of -Gal in various animal-derived medical products, hindering the treatment of several other pathologies.141 Since the discovery of AGS, many advancements have been made in order to obtain a better knowledge in terms of disease epidemiology, medical approach and molecular mechanisms. Nevertheless, current diagnostic methods lack specificity or are too risky for routinary appliance, creating the need to overcome these limitations with more precise methods. Also, a uniformization-based approach of diagnostic guidelines could be beneficial, creating comparable data and offering an opportunity to improve clinical decision-making accuracy. Further diagnostic, treatment and preventive advances will only be possible if the molecular and immune mechanisms behind AGS are uncovered. Furthermore, it is of utmost importance to identify tick salivary molecules, with or without -Gal modifications, that trigger IgE sensitivity as they could be the key for further vaccine development. With climate change, the tick-host paradigm will shift towards an increasing number of AGS cases in new regions worldwide,22 which will pose new challenges for clinicians in the future.

Research on AGS was funded by Ministerio de Ciencia e Innovacin/Agencia Estatal de Investigacin MCIN/AEI/10.13039/501100011033, Spain and EU-FEDER (Grant BIOGAL PID2020-116761GB-I00). R. Vaz-Rodrigues was supported by a doctoral contract (2022/20675) from Universidad de Castilla-La Mancha (UCLM), Spain, co-financed by the European Social Fund (ESF). L. Mazuecos was supported by a post-doctoral grant (2021-POST-32002) from UCLM co-financed by ESF.

The authors declare that they have no conflicts of interest in this work.

1. Hils M, Wlbing F, Hilger C, Fischer J, Hoffard N, Biedermann T. The history of carbohydrates in type I allergy. Front Immunol. 2020;11(10):114. doi:10.3389/fimmu.2020.586924

2. Hilger C, Fischer J, Wlbing F, Biedermann T. Role and mechanism of Galactose-Alpha-1,3-Galactose in the elicitation of delayed anaphylactic reactions to red meat. Curr Allergy and Asthma Rep. 2019;19(1):111. doi:10.1007/s11882-019-0835-9

3. Galili U. Evolution in primates by Catastrophic-selection interplay between enveloped virus epidemics, mutated genes of enzymes synthesizing carbohydrate antigens, and natural anti-carbohydrate antibodies. Am J Phys Anthropol. 2019;168(2):352363. doi:10.1002/ajpa.23745

4. Commins SP, Satinover SM, Hosen J, et al. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose--1,3-galactose. J Allergy Clin Immunol. 2009;123(2):426433.e2. doi:10.1016/j.jaci.2008.10.052

5. Fischer J, Yazdi AS, Biedermann T. Clinical spectrum of -Gal syndrome: from immediate-type to delayed immediate-type reactions to mammalian innards and meat. Allergo J Int. 2016;25(2):5562. doi:10.1007/s40629-016-0099-z

6. elebiolu E, Akarsu A, ahiner M. IgE mediated food allergy throughout the life. Turk J Med Sci. 2021;51(1):4960. doi:10.3906/sag-2006-95

7. Fischer J, Reepschlger T, Schricker T, Raap U. Alpha-gal syndrome: overview of clinical presentation and pathophysiology. Hautarzt. 2022;73(3):195200. doi:10.1007/s00105-022-04943-4

8. Chinuki Y, Takahashi H, Morita E. IgE antibodies to galactose--1,3-galactose, an epitope of red meat allergen, cross-react with a novel flounder roe allergen. J Investig Allergol Clin Immunol. 2021;32(4):17. doi:10.18176/jiaci.0754

9. Dunkman WJ, Rycek W, Manning MW. What does a red meat allergy have to do with anesthesia? Perioperative management of alpha-gal syndrome. Anesth Analg. 2019;129(5):12421248. doi:10.1213/ANE.0000000000003460

10. Cabezas-Cruz A, Hodi A, Romn-Carrasco P, et al. Environmental and molecular drivers of the -Gal syndrome. Front Immunol. 2019;10(5):112. doi:10.3389/fimmu.2019.01210

11. Cabezas-Cruz A, Valds J, de la Fuente J. Cancer research meets tick vectors for infectious diseases. Lancet Infect Dis. 2014;14(10):916917. doi:10.1016/S1473-3099(14)70902-8

12. Chung CH, Mirakhur B, Chan E, et al. Cetuximab-induced anaphylaxis and IgE specific for Galactose--1,3-Galactose. N Engl J Med. 2008;358(11):11091117. doi:10.1056/nejmoa074943

13. de la Fuente J, Pacheco I, Villar M, Cabezas-Cruz A. The alpha-Gal syndrome: new insights into the tick-host conflict and cooperation. Parasit Vectors. 2019;12(1):15. doi:10.1186/s13071-019-3413-z

14. Rodrguez Y, Rojas M, Gershwin ME, Anaya JM. Tick-borne diseases and autoimmunity: a comprehensive review. J Autoimmun. 2018;88(3):2142. doi:10.1016/j.jaut.2017.11.007

15. Cabezas-Cruz A, Mateos-Hernndez L, Chmela J, Villar M, de la Fuente J. Salivary prostaglandin E2: role in tick-induced allergy to red meat. Trends Parasitol. 2017;33(7):495498. doi:10.1016/j.pt.2017.03.004

16. Romn-Carrasco P, Hemmer W, Cabezas-Cruz A, Hodi A, de la Fuente J, Swoboda I. The -Gal syndrome and potential mechanisms. Front Allergy. 2021;2(12):117. doi:10.3389/falgy.2021.783279

17. Ramasamy R. Mosquito vector proteins homologous to 1-3 galactosyl transferases of tick vectors in the context of protective immunity against malaria and hypersensitivity to vector bites. Parasit Vectors. 2021;14(1):16. doi:10.1186/s13071-021-04801-7

18. Wilson JM, Schuyler AJ, Schroeder N, Platts-Mills TAE. Galactose--1,3-Galactose: atypical food allergen or model IgE hypersensitivity? Curr Allergy Asthma Rep. 2017;17(1):39. doi:10.1007/s11882-017-0672-7

19. Cabezas-Cruz A, Hodi A, Mateos-Hernandez L, Contreras M, De La Fuente J. Tick-human interactions: from allergic klendusity to the -Gal syndrome. Biochem J. 2021;478(9):17831794. doi:10.1042/BCJ20200915

20. Carson AS, Gardner A, Iweala OI. Wheres the beef? Understanding allergic responses to red meat in alpha-gal syndrome. J Immunol. 2022;208(2):267277. doi:10.4049/jimmunol.2100712

21. Wong XL, Sebaratnam DF. Mammalian meat allergy. Int J Dermatol. 2018;57(12):14331436. doi:10.1111/ijd.14208

22. Young I, Prematunge C, Pussegoda K, Corrin T, Waddell L. Tick exposures and alpha-gal syndrome: a systematic review of the evidence. Ticks Tick Borne Dis. 2021;12(3):101674. doi:10.1016/j.ttbdis.2021.101674

23. Diaz JH. Red meat allergies after Lone Star tick (Amblyomma americanum) bites. South Med J. 2020;113(6):267274. doi:10.14423/SMJ.0000000000001102

24. van Nunen S. Tick-induced allergies: mammalian meat allergy, tick anaphylaxis and their significance. Asia Pac Allergy. 2015;5(1):316. doi:10.5415/apallergy.2015.5.1.3

25. Platts-Mills TAE, Commins SP, Biedermann T, et al. On the cause and consequences of IgE to galactose--1,3-galactose: a report from the National Institute of Allergy and Infectious Diseases Workshop on understanding IgE-mediated mammalian meat allergy. J Allergy Clin Immunol. 2020;145(4):10611071. doi:10.1016/j.jaci.2020.01.047

26. Joral A, Azketa N, Sanchez P, et al. The quantification of IgG specific to -Gal could be used as a risk marker for suffering mammalian meat allergy. Foods. 2022;11(3):466. doi:10.3390/foods11030466

27. McGain F, Welton R, Solley GO, Winkel KD. First fatalities from tick bite anaphylaxis. J Allergy Clin Immunol Pract. 2016;2(7):309314. doi:10.1080/21674086.1933.11925177

28. Mullins RJ, Wainstein BK, Barnes EH, Liew WK, Campbell DE. Increases in anaphylaxis fatalities in Australia from 1997 to 2013. Clin Exp Allergy. 2016;46(8):10991110. doi:10.1111/cea.12748

29. Commins SP. Invited commentary: alpha-gal allergy: tip of the iceberg to a pivotal immune response. Curr Allergy Asthma Rep. 2016;16(9):13. doi:10.1007/s11882-016-0641-6

30. Levin M, Apostolovic D, Biedermann T, et al. Galactose -1,3-galactose phenotypes: lessons from various patient populations. Ann Allergy Asthma Immunol. 2019;122(6):598602. doi:10.1016/j.anai.2019.03.021

31. Zurbano-Azqueta L, Antn-Casas E, Duque-Gmez S, Jimnez-Gmez I, Fernndez-Pelln L, Lpez-Gutirrez J. Alpha-gal syndrome. Allergy to red meat and gelatin. Rev Clin Esp. 2021. doi:10.1016/j.rceng.2021.06.005

32. Mateo-Borrega MB, Garcia B, Larramendi CH, et al. Ige-mediated sensitization to galactose--1,3-galactose (-gal) in urticaria and anaphylaxis in Spain: geographical variations and risk factors. J Investig Allergol Clin Immunol. 2019;29(6):436443. doi:10.18176/jiaci.0373

33. Fischer J, Lupberger E, Hebsaker J, et al. Prevalence of type I sensitization to alpha-gal in forest service employees and hunters. Allergy. 2017;72(10):15401547. doi:10.1111/all.13156

34. Villalta D, Pantarotto L, Da Re M, et al. High prevalence of sIgE to Galactose-1,3-galactose in rural pre-Alps area: a cross-sectional study. Clin Exp Allergy. 2016;46(2):377380. doi:10.1111/cea.12655

35. Mitchell CL, Lin FC, Vaughn M, Apperson CS, Meshnick SR, Commins SP. Association between Lone Star tick bites and increased alpha-gal sensitization: evidence from a prospective cohort of outdoor workers. Parasit Vectors. 2020;13(1):14. doi:10.1186/s13071-020-04343-4

36. Venturini M, Lobera T, Sebastin A, Portillo A, Oteo JA. IgE to -Gal in foresters and forest workers from La Rioja, North of Spain. J Investig Allergol Clin Immunol. 2018;28(2):106112. doi:10.18176/jiaci.0218

37. Cabezas-Cruz A, de la Fuente J, Fischer J. Prevalence of type I sensitization to alpha-gal in forest service employees and hunters: is the blood type an overlooked risk factor in epidemiological studies of the -Gal syndrome? Allergy. 2017;72(12):20442047. doi:10.1111/all.13206

38. Cabezas-Cruz A, Mateos-Hernndez L, Alberdi P, et al. Effect of blood type on anti-a-Gal immunity and the incidence of infectious diseases. Exp Mol Med. 2017;49(3):e301e301. doi:10.1038/emm.2016.164

39. Yilmaz B, Portugal S, Tran TM, et al. Gut microbiota elicits a protective immune response against malaria transmission. Cell. 2014;159(6):12771289. doi:10.1016/j.cell.2014.10.053

40. Urra JM, Ferreras-Colino E, Contreras M, et al. The antibody response to the glycan -Gal correlates with COVID-19 disease symptoms. J Med Virol. 2021;93(4):20652075. doi:10.1002/jmv.26575

41. Steinke JW, Platts-Mills TAE, Commins SP. The alpha-gal story: lessons learned from connecting the dots. J Allergy Clin Immunol. 2015;135(3):589596. doi:10.1016/j.jaci.2014.12.1947

42. Commins SP. Diagnosis & management of alpha-gal syndrome: lessons from 2500 patients. Expert Rev Clin Immunol. 2020;16(7):667677. doi:10.1080/1744666X.2020.1782745

43. Lopes JP, Sicherer S. Food allergy: epidemiology, pathogenesis, diagnosis, prevention, and treatment. Curr Opin Immunol. 2020;66:5764. doi:10.1016/j.coi.2020.03.014

44. Antunes J, Borrego L, Romeira A, Pinto P. Skin prick tests and allergy diagnosis. Allergol Immunopathol. 2009;37(3):155164. doi:10.1016/S0301-0546(09)71728-8

45. Shroba J, Rath N, Barnes C. Possible role of environmental factors in the development of food allergies. Clin Rev Allergy Immunol. 2019;57(3):303311. doi:10.1007/s12016-018-8703-2

46. Jacquenet S, Moneret-Vautrin DA, Bihain BE. Mammalian meat-induced anaphylaxis: clinical relevance of anti-galactose--1,3-galactose IgE confirmed by means of skin tests to cetuximab. J Allergy Clin Immunol. 2009;124(3):603605. doi:10.1016/j.jaci.2009.06.014

47. Mateos-Hernndez L, Villar M, Moral A, et al. Tick-host conflict: immunoglobulin E antibodies to tick proteins in patients with anaphylaxis to tick bite. Oncotarget. 2017;8(13):2063020644. doi:10.18632/oncotarget.15243

48. Hocaoglu AB, Cipe F, Aydogmus C. Are skin prick tests really safe? A case of anaphylaxis caused by skin prick testing with inhalant allergens. Allergol Immunopathol. 2015;43(2):215216. doi:10.1016/j.aller.2013.09.011

49. Alns M. Anaphylaxis following prick-by-prick testing with peanut. Clin Case Rep. 2020;8(12):23662368. doi:10.1002/ccr3.3154

50. Chiriac AM, Bousquet J, Demoly P. In vivo methods for the study and diagnosis of allergy. In: Burks AW, Holgate ST, OHehir RE, et al. editors. Middletons Allergy: Principles and Practice. 9th ed. Elsevier; 2020:11191132. doi:10.1016/B978-0-323-08593-9.00071-1

51. Calvani M, Bianchi A, Reginelli C, Peresso M, Testa A. Oral food challenge. Medicina. 2019;55(10):116. doi:10.3390/medicina55100651

52. de la Fuente J, Cabezas-Cruz A, Pacheco I. Alpha-gal syndrome: challenges to understanding sensitization and clinical reactions to alpha-gal. Expert Rev Mol Diagn. 2020;20(9):905911. doi:10.1080/14737159.2020.1792781

53. Mehlich J, Fischer J, Hilger C, et al. The basophil activation test differentiates between patients with alpha-gal syndrome and asymptomatic alpha-gal sensitization. J Allergy Clin Immunol. 2019;143(1):182189. doi:10.1016/j.jaci.2018.06.049

54. Mabelane T, Basera W, Botha M, Thomas HF, Ramjith J, Levin ME. Predictive values of alpha-gal IgE levels and alpha-gal IgE: total IgE ratio and oral food challenge proven meat allergy in a population with a high prevalence of reported red meat allergy. Pediatr Allergy Immunol. 2018;29(8):841849. doi:10.1111/pai.12969

55. Eberlein B, Mehlich J, Reidenbach K, et al. Negative oral provocation test with porcine pancreatic enzyme plus cofactors despite confirmed -gal syndrome. J Investig Allergol Clin Immunol. 2020;30(6):468469. doi:10.18176/jiaci.0513

56. Morisset M, Richard C, Astier C, et al. Anaphylaxis to pork kidney is related to IgE antibodies specific for galactose-alpha-1,3-galactose. Allergy. 2012;67(5):699704. doi:10.1111/j.1398-9995.2012.02799.x

57. Fischer J, Biedermann T. Delayed immediate-type hypersensitivity to red meat and innards: current insights into a novel disease entity. J Dtsch Dermatol Ges. 2016;14(1):3843. doi:10.1111/ddg.12821

58. Jappe U, Minge S, Kreft B, et al. Meat allergy associated with galactosyl--(1,3)-galactose (-Gal)-Closing diagnostic gaps by anti--Gal IgE immune profiling. Allergy. 2018;73(1):93105. doi:10.1111/all.13238

59. Leung DYM, Szefler SJ. Tick bites: a common cause of IgE antibodies to alpha-gal. J Allergy Clin Immunol. 2011;127(5):11311132. doi:10.1016/j.jaci.2011.03.019

60. Chinuki Y, Morita E. Alpha-Gal-containing biologics and anaphylaxis. Allergol Int. 2019;68(3):296300. doi:10.1016/j.alit.2019.04.001

61. Mabelane T, Ogunbanjo GA. Ingestion of mammalian meat and alpha-gal allergy: clinical relevance in primary care. Afr J Prim Health Care Fam Med. 2019;11(1):15. doi:10.4102/phcfm.v11i1.1901

62. Park Y, Kim D, Boorgula GD, et al. Alpha-gal and cross-reactive carbohydrate determinants in the N-Glycans of salivary glands in the Lone Star Tick, Amblyomma americanum. Vaccines. 2020;8(1):116. doi:10.3390/vaccines8010018

63. Apostolovic D, Grundstrm J, Perusko M, et al. Course of IgE to -Gal in a Swedish population of -Gal syndrome patients. Clin Transl Allergy. 2021;11(10):24. doi:10.1002/clt2.12087

64. Gonzalez-Quintela A, Dam Laursen AS, Vidal C, Skaaby T, Gude F, Linneberg A. IgE antibodies to alpha-gal in the general adult population: relationship with tick bites, atopy, and cat ownership. Clin Exp Allergy. 2014;44(8):10611068. doi:10.1111/cea.12326

65. Wilson JM, Keshavarz B, Retterer M, et al. A dynamic relationship between two regional causes of IgE-mediated anaphylaxis: -Gal syndrome and imported fire ant. J Allergy Clin Immunol. 2021;147(2):643652.e7. doi:10.1016/j.jaci.2020.05.034

66. Passanisi S, Lombardo F, Crisafulli G, Salzano G, Aversa T, Pajno GB. Novel diagnostic techniques and therapeutic strategies for IgE-mediated food allergy. Allergy Asthma Proc. 2021;42(2):124130. doi:10.2500/AAP.2021.42.200129

Read this article:
Diagnosis and treatment of the alpha-Gal syndrome | JAA - Dove Medical Press

Bastyr University is proud to announce its first fully online degree program, the Master of Science in Integrative Nutrition.

KENMORE, Wash., July 14, 2022 /PRNewswire-PRWeb/ -- Bastyr University announces the launch of its Master of Science in Integrative Nutrition (MSIN), available online starting Fall 2022. The MSIN is an accelerated, two-year program that prepares its graduates to be integrative nutrition experts. The program allows students in the program to take one course at a time, making it ideal for adults working full-time.

Bastyr created the online MSIN program in response to demand from prospective students outside of the geographic radii of its Seattle and San Diego area campuses, as well as to address the need for integrative nutrition experts in our health system.

"Making innovative nutrition education accessible to more people, everywhere, is a step forward for Bastyr University and the people our graduates serve as they help others build healthier bodies, minds, and spirits," says Bastyr University President Devin Byrd, Ph.D."It's online, one course at a time format makes this ideal for working professionals everywhere."

Upon degree completion, graduates can continue their education at the doctoral level or move into the workplace in areas such as:

A key distinction of this program is its intersectionality of diet, lifestyle, environment, and culture. MSIN students learn about culinary medicine, dietary supplementation, disease prevention through nutrition, social justice and food systems, whole food nutrition, and gain research skills that foster a passion for lifelong learning.

Bastyr University is an accredited, nonprofit, private university offering doctoral,graduate,and undergraduate degrees, with a multidisciplinary curriculum in science-based natural health and medicine. Recognized globally for its rigorous curriculum and strong research, Bastyr University has campuses in Kenmore, Washington, and San Diego, California. Bastyr's facultyeducatefuture leaders in the natural health arts and sciences, with an emphasis on integrating mind, body,spirit,and nature.

For more information about the MSIN program, visit https://bastyr.edu/academics/nutrition/master-science-integrative-nutrition-online.

Media Contact

Nicole Francois, Bastyr University, 206.799.4414, nicole@marketwellnow.com

SOURCE Bastyr University

Here is the original post:
New Online Program: Master of Science in Integrative Nutrition - Classes Begin Fall 2022 - Benzinga - Benzinga

Summit Led by Dr. and Master Zhi Gang Sha Features Conversations with Dr. Deepak Chopra, Dr. Ervin Laszlo, Dr. Rulin Xiu

Quarterly Held Event Targeting Spirituality and Science Will Help People Navigate Unprecedented Challenges of 2022

NEW YORK, July 8, 2022 /PRNewswire/ --As millions of Americans continue to grapple with strife in their daily lives caused by a continuing global pandemic, a looming economic recession, lingering social injustices, upsetting political upheavals, and heartbreaking events including deadly mass shootings and fighting in Europe unseen since World War II, a diverse cross section of the world's leading spiritual and wellness icons, humanitarians, philanthropists, philosophers and physicists are launching a series of events to raise awareness about the science of spirituality and help people navigate the unprecedented challenges of 2022.

"Tapping the Source" is an online science and spirituality summit premiering on July 16 that will be held quarterly for the remainder of 2022 and beyond. Leading the effort is Dr. and Master Zhi Gang Sha, a Tao Grandmaster who has authored more than 10 New York Times bestselling books, and the first panel of guest speakers includes Dr. Deepak Chopra, a world-renowned pioneer in integrative medicine, Dr. Ervin Laszlo, an accomplished philosopher and two-time Nobel Peace Prize nominee, and Dr. Rulin Xiu, a University of California, Berkeley trained quantum physicist who heads the Hawaii Theoretical Physics Research Center.

Responding to an overwhelming need for mental health and wellbeing, and as millions of people are meditating and seeking inner peace, "Tapping The Source" will offer conversations with experts sharing their original discoveries and insights about the science of spirituality. With their own unique perspectives, each panelist will explain how every person has the power to transform their own reality and also have a dramatic impact on the world. This is a rare chance to expand the public's understanding of complex sciences and connect with deeper, underlying sources of life.

Story continues

Once recognized by Maya Angelou in her own powerful words, "We, the human race, need more Zhi Gang Sha," Dr. and Master Sha combines 5,000-year-old Soulfulness practices together with 21st-century innovations to successfully help celebrities, entrepreneurs, athletes, scientists and everyday people tap into a power, passion, clarity, and purpose they didn't even know they had.

"I am honored to join together with these outstanding thinkers who are revolutionizing how we understand the nature of consciousness and the power of quantum healing," said Dr. and Master Sha. "The mind is just one piece of a bigger puzzle at play, and it is essential for people to align their heart and soul to overcome challenges affecting health, relationships, careers, and beyond."

The online summit will take place on July 16 from 12pm to 5pm. For more information and tickets, visit http://www.tappingthesource.org 100% of proceeds will support The Chopra Foundation, The Love Peace Harmony Foundation, and the Laszlo Institute of New Paradigm Research, a range of community-serving non-profits established by the program speakers. Tapping the Source is an initiative by Universal Soul Service Corp.

About Tapping The Source July 16 Speakers

Dr. and Master Zhi Gang Sha a Tao Grandmaster, international spiritual teacher, and 11-times New York Times bestselling author as well as an M.D from China and Doctor of Traditional Chinese Medicine in China and Canada. Founder of Tao Academy, the Love Peace Harmony Foundation, the Sha Research Foundation, and the Tao Calligraphy meditation practice - combining the essence of modern Western medicine with ancient Taoist teachings to help people lead happier and healthier lives. Awarded the Martin Luther King, Jr. Commemorative Commission Award for promoting world peace. Featured on PBS with 'The Power of Soul' and 'Soul Healing Miracles'. Appointed to the position of Shu Fa Jia (National Chinese Calligrapher Master) as well as Yan Jiu Yuan (Honorable Researcher Professor) at the State Ethnic of Academy of Painting in China.

Connect on social media:

Dr. Deepak Chopra World-renowned pioneer in integrative medicine and personal transformation and author of over 90 books, MD, FACP, founder of The Chopra Foundation, a non-profit entity for research on well-being and humanitarianism, and Chopra Global, a modern-day Health company at the intersection of science and spirituality.

Dr. Ervin Laszlo Renowned philosopher and systems scientist. Twice nominated for the Nobel Peace Prize, he has published more than 101 books and over 400 research papers and was the subject of the PBS Documentary Life of a Modern-Day Genius. Laszlo is the founder and president of the international think tank, The Club of Budapest.

Dr. Rulin Xiu - Ph.D.,University of California, Berkeley. Quantum physicist, co-founder of Tao Science, Research Director for the Hawaii Theoretical Physics Research Center, and co-author of the international bestselling book,Tao Science: The Science, Wisdom, and Practice of Creation and Grand Unification.

https://www.tappingthesource.org/

Contact:Michael JohnstonCo-Communications(617) 549-0639mjohnston@cocommunications.com

Cision

View original content:https://www.prnewswire.com/news-releases/tapping-the-source-series-debuts-on-july-16-with-worlds-leading-wellness-icons-humanitarians-philosophers-physicists-301583046.html

SOURCE Universal Soul Service Corp.

See more here:
"TAPPING THE SOURCE" SERIES DEBUTS ON JULY 16 WITH WORLD'S LEADING WELLNESS ICONS, HUMANITARIANS, PHILOSOPHERS, PHYSICISTS - Yahoo Finance

New York-based multidisciplinary design studio OSD has announced that it has been selected to work alongside lead project architect Polk Stanley Wilcox to envision the landscape of the forthcoming Alice L. Walton School of Medicine in Bentonville, Arkansas. Formerly known as the Whole Health School of Medicine and Health Sciences, the first-of-its kind medical school will encompass a 154,000-square-foot building that shares a sylvan 120-acre campus with Waltons Crystal Bridges Museum of American Art, designed by Safdie Architects, and the Marlon Blackwell Architects-designed Whole Health Institute.

The site, new name, and initial renderings of the building and landscape were first released late last month following the inaugural meeting of the Alice L. Walton School of MedicineBoard of Directors.

Construction on the facility, now in the design development phase, is slated to kick off next spring and is anticipated to begin welcoming its first class of students in fall 2025. Once up and running (and accredited), the school will offer a four-year, medical degree-granting program integrating conventional medicine with holistic principles and self-care practices, according to a press release.

The new School of Medicine, which Walton described in a press statement as an inspiring learning environment that supports well-being, emphasizes innovation, and equips future physicians to be agents of change, is the latest project to take root amidst a flurry of major ongoing works at and around Crystal Bridges, which first opened in this particularly tranquil pocket of Northwest Arkansas in 2011. These projects include a sizable, Safdie Architects-led expansion of Crystal Bridges itself, which won approval from Bentonville Planning Commission last October, and the Whole Health Institute, which is currently under construction and is slated to open in 2024. Work is also underway on a six-story, multi-use parking structure (also designed by Marlon Blackwell Architects) and Convergence, a 4-acre playscape launched by Crystal Bridges in collaboration with the Scott Family Amazeum, a neighboring interactive childrens museum that opened in 2015.

As for the OSD-led landscape scheme at the new School of Medicine, it will be seamlessly fused to the Whole Health Institute and Crystal Bridges, located to the west, via a network of bike and walking trails weaving through a dense patch of Ozakarian forest spread across the larger campus. This, as a press announcement described, will create a link between art, nature and healing for a holistic learning environment. OSDs proposal envisions a lush rooftop park-slash-terrace crowning the new building, which will feature a protective bluff shelter on its front facade along J Street, and an overall focus on holistically integrating the new building with the surrounding woodlands. Other key landscape features will include gardens for healing, foraging, and woodland meditation, urban farming space, wetlands, outdoor classrooms, and an amphitheater.

Designing the landscape for the Alice L. Walton School of Medicine truly requires an integrative approach that considers the experience, influence and impact of nature on the mind, body and spirit, elaborated Simon David, founding principal and creative director of OSD. The project offers an exciting new paradigm of healing and learning environments that holistically blends building and landscape to create a deeply rooted connection to the Bentonville community, the world-class arts environment of Crystal Bridges and the wider ecosystem and magic of the Ozarks.

The design integrates the building into both the site and the community, engaging the land as an abstraction of Ozark geology that embraces the principles of integrated medicine, and the holistic link between mental, physical, and spiritual well-being, added Wesley Walls, principal with Fayetteville- and Little Rockbased Polk Stanley Wilcox.

Another OSD landscape project recently profiled by AN is The Shepherd, an ambitious community arts campus in Detroits East Village anchored by a revitalized 110-year-old Catholic Church.

Back in Bentonville, Crystal Bridges just unveiled its first-ever exhibition dedicated to American fashion design, Fashioning America: Grit to Glamour. Also recently on view is We the People: The Radical Notion of Democracy, which features a rare original print of the U.S. Constitution.

Well check back in with Crystal Bridges newest health- and wellness-focused neighbor as the project moves along.

See the original post:
OSD tapped to design the Alice L. Walton School of Medicine in Arkansas - The Architect's Newspaper

When most people think of cactus, a prickly plant probably comes to mind. But pretty soon, cactus water, a beverage with trace minerals and a natural fruity flavor, may also be on everyones radar, available at your local health food store next to the coconut water and sea moss gel.

Cactus water is hot in the functional beverage space, just like coconut water, because its a plant-based beverage that contains electrolytes and antioxidants, says Vicki Shanta Retelny, RDN, the Chicago-based creator of the podcastNourishing Notes.

Still, not all commercial cactus waters are created equal. They could be healthy or [they] could be adulterated and not beneficial, says Ann Marie Chiasson MD, MPH, the director of the fellowship in integrative medicine at the Andrew Weil Center for Integrative Medicine in Tuscson, Arizona.

Heres what you need to know about cactus water before you head to the store to stock up.

Cactus water is sourced from prickly pear cactus pads, also called nopals, and fruit according to aMay 2020 article in Food Reviews International. Prickly pears originated in Mexico, and the Aztecs used the plant medicinally, as theUniversity of Chicago Illinois Heritage Garden notes.

While most people buy it at the store, it is possible to make cactus water yourself (more on that later).

Cactus water is sometimes compared to coconut water, thanks to its naturally occurring electrolytes minerals such as potassium that are needed for multiple bodily functions, according to Cedars-Sinai.

That said, some cactus water brands claim to contain less than half the calories and sugar in coconut water. And that's a reasonable claim: According to the U.S. Department of Agriculture (USDA), 100 milliliters (ml) (about cup) of coconut water contains the following:

Not all cactus water is the same. The minerals in your water will depend on the brand you choose. Two popular companies, Caliwater and True Nopal, offer small amounts of carbohydrates, as well as the electrolytes magnesium and potassium.

True Nopal

According to the USDA, 100 ml of True Nopal contains:

Caliwater

Meanwhile, 100 ml of Caliwater, according to the USDA, contains:

Scientific research doesnt support most of the proposed benefits of cactus water. But here are some of the theoretical perks of the ingredient.

According to an article posted by the Mayo Clinic, prickly pear cactus contains antioxidants that may lower inflammation. The registered dietitian-nutritionist queried refers to a study published in Food & Nutrition Research in August 2018, in which healthy volunteers ate prickly pear cactus fruit for two weeks and had statistically lower pro-inflammatory markers than a control group of people who didnt eat the fruit.

Prickly pear also contains betalains, anti-inflammatory pigments known for their pink hue and antioxidant properties.

And just how much cactus water would a person with diabetes need to drink to garner those touted benefits? Theres not enough research, and the dose is not determined, says Dr. Chiasson. A review published in May 2019 in the journal Medicina even notes a lack of evidence for the use of prickly pear products to mitigate type 2 diabetes risk or to manage the disease. Specifically, the authors wrote that it doesnt appear to have a significant effect on glucose or insulin.

Then theres the added sugars in some of these products, which could be harmful to people with diabetes.

Theoretically, a swig of cactus water after a night of drinking may offer a hangover remedy because it contains electrolytes. As MedlinePlus notes, electrolyte solutions can help you replenish some of the electrolytes you lose after drinking alcohol heavily.

Retelny points out that people have traditionally used cactus water as a topical elixir for wounds and overly sun exposed skin. (Alaboratory study published in December 2017 in Bioorganic and Medicinal Chemistry Letters of prickly pear cactus extracts on human skin cells exposed to UV light supports this.) That said, scientists havent tested this hypothesis on commercial cactus water beverages, just concentrated extract, and more studies are needed.

A few studies show this drink may benefit people living with certain digestive issues, but the research is preliminary and in animals. For example, astudy published in the Journal of Medicinal Food found that prickly pear cactus protected against stress-induced acute gastric lesions in rats. Another study, published in January 2017 in the journal BMC Complementary and Alternative Medicine, found that prickly pear relieved constipation in rats. That doesnt mean those effects would happen in humans. In general, more human studies are needed to determine cactus waters beneficial effects in the body, says Retelny.

Mayo Clinic notes that cactus water may have some side effects, including diarrhea and nausea. Adds Retelny, Cactus water may cause gastrointestinal distress due to its laxative nature. It may also cause headaches and hypoglycemia. Though the latter risk may be low, judging by the results of the aforementioned Medicina paper, Retelny says people on blood-sugar-lowering medications, including people with diabetes, should be cautious about drinking cactus water check with your healthcare team first (that goes for anyone who is on medication or managing an underlying health condition).

Another thing to be mindful of, nutritionally speaking: If theres added sugar in cactus water, moderate how much you drink, says Retelny. Check the label of any store-bought cactus water to see if it's loaded with added sugar. Aim for less than 10 percent of daily calories from added sugars, Retelny adds.

If your doctor says you can safely drink cactus water, you may consider DIYing it. To do so, acquire a prickly pear cactus fruit that's had its spines removed these are available at Lowes and other stores. Boil the fruit in water and scoop out the flesh, then strain it through cheesecloth to extract the liquid, says Retelny. You can add water or sweetener if its too concentrated or the flavor of the plain fruit is too strong, and then you can store it in the refrigerator for up to three days, she suggests. (Note: Don't add too much sweetener, or it'll lose its status as a healthful drink.)

Some people will freeze [the fruit], which allows it to pop open and then defrost it and squeeze it through cheesecloth to remove the spines, says Chiasson, who says she makes cactus water in the summer months and adds it to recipes.

Research on cactus water is lacking, and it has few proven health benefits, but overall it seems to offer a relatively low-carb, low-calorie alternative to coconut water (and it may have a more pleasant taste) if you want a hydrating drink that will replenish electrolytes. I always say theres nothing wrong with trying new products, such as cactus water, but know your own health limitations and start with small amounts, says Retelny.

Remember to always check out the label so you know whats in there, too. Look at almond milk some are good and some are not; some use very few almonds and add a lot of sugar, says Chiasson. And understand that this drink isn't a magic potion. Nothing beats a balanced diet filled with whole plant foods and plenty of water throughout the day, Retelny adds.

Read more:
Cactus Water: Is It Good for You? - Everyday Health

If you throw back a handful of vitamins and minerals every morning, it might be time to look into enzymes as a way to fully round out your routine. Specifically, CoQ10 and all of its many benefits.

The antioxidant CoQ10 is short for coenzyme Q10 and is also known as ubiquinone, says Dr. Carrie Lam, MD, FAAMFM, ABAARM, the medical director and co-founder of integrative medicine facility Lam Clinic. Cells use this substance to produce essential energy, which is needed for cells to grow and maintain themselves, Dr. Lam tells Bustle. In fact, CoQ10 is so vital to the production of energy that it has the highest concentration in the organs that require the most energy such as the heart, liver, and kidneys.

You can get a dose of CoQ10 from foods like organ meats like liver, wild-caught fish, olive oil, peanuts, and broccoli, says DJ Mazzoni, MS, RD, CDN, CSCS, a registered dietician and medical reviewer for Illuminate Health, a health product review site. But the amount of CoQ10 found in food often isnt enough to meet your recommended daily allowance (RDA).

Another thing? Although your body can make some CoQ10, production declines with age, adds registered dietician Anna Bohnengel, MS, RD, LD. Chronic inflammation, poor liver function, and certain medications, like statins, can also deplete CoQ10. For more info on the benefits of CoQ10, and why you might want to add it to your supplement routine, read on below.

More than 4,000 different clinical studies have been conducted about CoQ10 side effects, and all of them have proved that higher levels of CoQ10 indicate that a person will lead a life that is healthier and longer, Dr. Lam says.

And this is especially true as it pertains to heart health. For example, three out of every four individuals who suffer from heart conditions have been found to have major deficiencies of CoQ10, Dr. Lam explains. When those with heart problems were given CoQ10, their conditions were found to improve.

CoQ10 has also been shown to lower high cholesterol, Dr. Lam says. This is because high cholesterol is known to lower the levels of CoQ10 produced in the body, causing a deficiency, she adds. Studies also support that high blood pressure could benefit or improve from an increase in CoQ10.

A 2019 meta-analysis published in Acta Neurologica Scandinavica noted that CoQ10 could help prevent migraines, which just so happen to be one of the most frequent neurological disorders in the world. According to the review, CoQ10 was found to shorten migraine duration, and it was more effective than a placebo in reducing the number of migraine days per month.

In patients with deficient levels of CoQ10, supplementing with the compound can improve energy levels because it increases ATP production, Mazzoni says. Thats why athletes care about CoQ10. Studies have shown that CoQ10 supplementation of about 60 to 100 mg a day for four to eight weeks improves aerobic power, anaerobic threshold, exercise performance, and/or recovery after exercise. While more studies are needed to really dig into how helpful CoQ10 is when it comes to boosting energy, its a supplement you may want to add to your routine, especially if youre a fan of working out.

While you may have spotted CoQ10 as a topical ingredient in skincare products, dietary supplementation of CoQ10 might also have an impact on skin texture. During a 2016 study published in BioFactors, researchers investigated the effects of 12 weeks of daily supplementation with 50 and 150 mg of CoQ10 on skin parameters and conditions. The results? Significantly reduced wrinkles and micro-relief lines, and improved skin smoothness.

CoQ10 is also important for the immune system, Dr. Lam says. According to a 2021 review published in Antioxidants (Basel), the enzyme plays a number of important roles in the cell that are required for the optimal functioning of the immune system.

The study notes that the immune response has intensive energy requirements, which is why an adequate supply of CoQ10 is therefore required to enable the various cell types of the immune system to function optimally.

CoQ10 also protects your health by playing an anti-inflammatory role. As Dr. Lam says, CoQ10 works the same way an antioxidant does by defending the body from damage caused by certain molecules known as free radicals. Your doctor may recommend it to ward off diseases, especially those that are age-related.

There are two forms of CoQ10: ubiquinol and ubiquinone. Mazzoni recommends ubiquinol, as the same dosage leads to higher blood levels than ubiquinone.

If you find yourself puzzling over different bottles in the supplement aisle, go with one from a company that does third-party testing so that youll know your pill actually contains the stated levels of the compound, Mazzoni says.

If you follow a vegan or vegetarian diet, it might be helpful to add a CoQ10 supplement since you definitely arent digging into organ meats or wild-caught fish. Mazzoni also recommends asking your doctor to order a blood test to check CoQ10 levels, especially if youve been feeling tired. If youre in your 30s or 40s, your levels might already be starting to drop, he adds. A 40-year-old who is healthy will still have significantly lower CoQ10 levels than they would have had at 20.

Most of the medical research on CoQ10 establishes its effective dosing range at 100 milligrams (mg) to 200 mg per day, Mazzoni says. Once you start, it may take up to eight weeks before any changes occur, Dr. Lam adds. CoQ10 also isnt easily absorbed by the body, so check with your doctor to make sure your dose is correct.

While CoQ10 has very few side effects, Mazzoni says some folks might experience upper abdominal pain or loss of appetite when taking it, though its rare. This supplement can also interact with anticoagulant medication, he adds. So, as it goes with any supplement, its always a good idea to check in with your doctor before adding it to your routine.

Studies referenced:

Cooke, M. 2008. Effects of acute and 14-day coenzyme Q10 supplementation on exercise performance in both trained and untrained individuals. J Int Soc Sports Nutr. doi: 10.1186/1550-2783-5-8.

Jorat, MV. 2018. The effects of coenzyme Q10 supplementation on lipid profiles among patients with coronary artery disease: a systematic review and meta-analysis of randomized controlled trials. Lipids Health Dis. doi: 10.1186/s12944-018-0876-4.

Mantle, D. 2021. Coenzyme Q10 and Immune Function: An Overview. Antioxidants (Basel). doi: 10.3390/antiox10050759.

Tabrizi, R. 2018. The Effects of Coenzyme Q10 Supplementation on Blood Pressures Among Patients with Metabolic Diseases: A Systematic Review and Meta-analysis of Randomized Controlled Trials. High Blood Press Cardiovasc Prev. doi: 10.1007/s40292-018-0247-2.

Zeng, Z. 2019. Efficacy of CoQ10 as supplementation for migraine: A meta-analysis. Acta Neurol Scand. doi: 10.1111/ane.13051.

mitek, K. 2017. The effect of dietary intake of coenzyme Q10 on skin parameters and condition: Results of a randomised, placebo-controlled, double-blind study. Biofactors. doi: 10.1002/biof.1316.

Zozina, VI. 2018. Coenzyme Q10 in Cardiovascular and Metabolic Diseases: Current State of the Problem. Curr Cardiol Rev. doi: 10.2174/1573403X14666180416115428.

Sources:

Dr. Carrie Lam, MD, FAAMFM, ABAARM, medical director and co-founder of Lam Clinic

DJ Mazzoni, MS, RD, CDN, CSCS, registered dietician and medical reviewer for Illuminate Health

Anna Bohnengel, MS, RD, LD, registered dietician and fertility nutritionist

Get Even More From Bustle Sign Up For The Newsletter

From hair trends to relationship advice, our daily newsletter has everything you need to sound like a person whos on TikTok, even if you arent.

See the rest here:
The Benefits Of CoQ10 Supplements, According To Experts - Bustle

Fadel Zeidan, PhD, is an associate professor of anesthesiology at UC San Diego School of Medicine.

For centuries, people have been using mindfulness meditation to try to relieve their pain, but neuroscientists have only recently been able to test if and how this actually works. In the latest of these efforts, researchers at University of California San Diego School of Medicine measured the effects of mindfulness on pain perception and brain activity.

The study, published July 7, 2022 in PAIN, showed that mindfulness meditation interrupted the communication between brain areas involved in pain sensation and those that produce the sense of self. In the proposed mechanism, pain signals still move from the body to the brain, but the individual does not feel as much ownership over those pain sensations, so their pain and suffering are reduced.

One of the central tenets of mindfulness is the principle that you are not your experiences, said senior author Fadel Zeidan, PhD, associate professor of anesthesiology at UC San Diego School of Medicine. You train yourself to experience thoughts and sensations without attaching your ego or sense of self to them, and were now finally seeing how this plays out in the brain during the experience of acute pain.

On the first day of the study, 40 participants had their brains scanned while painful heat was applied to their leg. After experiencing a series of these heat stimuli, participants had to rate their average pain levels during the experiment.

Participants were then split into two groups. Members of the mindfulness group completed four separate 20-minute mindfulness training sessions. During these visits, they were instructed to focus on their breath and reduce self-referential processing by first acknowledging their thoughts, sensations and emotions but then letting them go without judging or reacting to them. Members of the control group spent their four sessions listening to an audio book.

On the final day of the study, both groups had their brain activity measured again, but participants in the mindfulness group were now instructed to meditate during the painful heat, while the control group rested with their eyes closed.

Researchers found that participants who were actively meditating reported a 32 percent reduction in pain intensity and a 33 percent reduction in pain unpleasantness.

We were really excited to confirm that you dont have to be an expert meditator to experience these analgesic effects, said Zeidan. This is a really important finding for the millions of people looking for a fast-acting and non-pharmacological treatment for pain.

When the team analyzed participants brain activity during the task, they found that mindfulness-induced pain relief was associated with reduced synchronization between the thalamus (a brain area that relays incoming sensory information to the rest of the brain) and parts of the default mode network (a collection of brain areas most active while a person is mind-wandering or processing their own thoughts and feelings as opposed to the outside world).

One of these default mode regions is the precuneus, a brain area involved in fundamental features of self-awareness, and one of the first regions to go offline when a person loses consciousness. Another is the ventromedial prefrontal cortex, which includes several sub regions that work together to process how you relate to or place value on your experiences. The more these areas were decoupled or deactivated, the more pain relief the participant reported.

For many people struggling with chronic pain, what often affects their quality of life most is not the pain itself, but the mental suffering and frustration that comes along with it, said Zeidan. Their pain becomes a part of who they are as individuals something they cant escape and this exacerbates their suffering.

By relinquishing the self-referential appraisal of pain, mindfulness meditation may provide a new method for pain treatment. Mindfulness meditation is also free and can be practiced anywhere. Still, Zeidan said he hopes trainings can be made even more accessible and integrated into standard outpatient procedures.

We feel like we are on the verge of discovering a novel non-opioid-based pain mechanism in which the default mode network plays a critical role in producing analgesia. We are excited to continue exploring the neurobiology of mindfulness and its clinical potential across various disorders.

Co-authors include: Gabriel Riegner, Valeria Oliva and William Mobley at UC San Diego, as well as Grace Posey at Tulane University and Youngkyoo Jung at University of California Davis.

This work was supported by the National Center for Complementary and Integrative Health (grants K99/R00-AT008238, R01-AT009693, R21-AT010352) and the UC San Diego T. Denny Sanford Institute for Empathy and Compassion.

Read more:
Mindfulness Meditation Reduces Pain by Separating it from the Self - University of California San Diego

This transcript has been edited for clarity.

Anna Pace, MD: Hi, everyone, and welcome. My name is Dr Anna Pace. I'm an assistant professor of neurology at the Icahn School of Medicine at Mount Sinai, and I direct the Headache Medicine Fellowship at Mount Sinai Hospital. Today, I'm lucky enough to be joined by my illustrious colleague, Dr Zhang.

Dr Zhang, would you like to introduce yourself?

Niushen Zhang, MD: Hi, Dr Pace. It's great to be here. I'm Dr Niushen Zhang. I'm a clinical assistant professor of neurology. I'm also the chief of headache medicine at Stanford University. Great to be here.

Pace: Today, we're going to be talking about complementary and integrative medicine for migraine. I think this is a topic that has sparked a lot of interest, especially on the patient side over the last couple of years. Dr Zhang, can you tell me a little bit about what exactly complementary and integrative medicine is?

Zhang: There are actually many definitions of it. What we generally think about are nonpharmaceutical treatment approaches or healthcare practices that may not be part of conventional medicine. The American Board of Integrative Medicine gives a very well-rounded definition of this, in which they say that it's a practice of medicine that focuses on the whole person, and it should be informed by evidence and make use of all of the appropriate treatment approaches that can help our patients achieve optimal health.

The name that we use to describe this field of medicine has changed over time. Initially, it was alternative medicine, then it was called complementary and alternative medicine, or CAM. The most recent term that we use is complementary and integrative medicine.

Pace: Or CIM, for short. I think CIM, based on what you're describing, sounds like it would fit well with headache medicine, in general, when we're thinking about all of the different factors that can potentially contribute to or affect a person's headache frequency. Some of the things that we always think about are lifestyle factors that can affect headaches.

Do you have any data or anything you'd like to talk about in terms of some of the different lifestyle factors that patients can work on when they are looking to try to reduce their headache frequency?

Zhang: First, we always want to think about which patients are a best fit for this type of treatment. We think about patients who may not have had adequate responses to their pharmaceutical treatments, who have poor tolerance to these treatments, or maybe some medical contraindication to medications. We also think about people who may be pregnant or lactating or planning pregnancy. These treatments can also be helpful for people who have medication overuse headache or exhibit significant stress and may not have adequate stress coping skills.

Really, the foundation is the lifestyle modifications. The way that I explain it to patients is basically your migraine brain is hypersensitive, especially to change. What it likes is a very regular and predictable schedule for eating, sleeping, and exercise.

Specifically, what we see for exercise is that about 20 minutes a day of aerobic exercise can actually decrease headache frequency and severity. This could be anything from devoted time to walking, hiking, biking, or swimming. Those can all be very helpful.

For sleep, poor sleep quality, including things like insomnia, can affect about 30% of patients with migraine. In our clinic, we always screen for any potential underlying sleep disorders, like sleep apnea. We want to make sure our patients receive appropriate evaluations and treatment for those conditions. What we find most helpful with sleep is just keeping the same bedtime and wake-up time every day, Monday through Sunday.

Of course, we get many questions about food and nutrition. The truth is the evidence is just not strong in this area at this time, for any specific dietary interventions. We always counsel our patients to keep a very regular and consistent meal schedule throughout the day and to avoid skipping meals. Patients also love to ask about food triggers, but the evidence is not strong for what foods must be avoided.

In practice, we find that food triggers are very individual for people. If someone finds that a certain food consistently triggers their migraines, then it would make sense to avoid that food, but in general, we don't encourage people to restrict their diet.

Pace: Exercise and sleep come up often in my clinic as well. Particularly for patients who find that exercise may trigger their attacks or they're hesitant to do any exercise because their attacks are so frequent, I often recommend gentler, low-impact exercises, like yoga, tai chi, or swimming, for example, which I think people find a little bit easier to warm up to or incorporate into their routine.

And really focusing on good sleep hygiene, and even things like trying to wind down before bed and having some type of routine, is really helpful. I have had a number of patients come to me and ask, "Is there anything, like vitamins or herbal supplements, that I can take to try to help prevent my attacks?" There is quite a number of them that have good evidence. What do you usually recommend for your patients?

Zhang: I'm glad you brought that up. There are, I would say, four that are evidence-based and very helpful for our patients. One of them is magnesium. That one has a level B recommendation from the American Academy of Neurology (AAN)/American Headache Society (AHS). We think it helps with calming down neuronal hyperexcitability and preventing cortical spreading depression. Some of the formulations we like are magnesium glycinate, magnesium oxide, and citrate. We do want to watch for any loose stool or diarrhea, because those are some of the common side effects that can potentially happen. The daily dosing is about 200-600 mg/d.

Other than magnesium, we also have vitamin B2 or riboflavin. That also has a level B recommendation, and it's well-tolerated. Some people do get very bright orange or yellow urine when they take it, and the dosing is around 400 mg. There's also coenzyme Q10, which has level C recommendation from AAN/AHS. It plays a role in the electron transport chain and may play an important role in sustaining mitochondrial energy stores. It's also very well-tolerated, and the daily dosing is about 300 mg.

The last one we have is something called feverfew, which is a type of chrysanthemum. This also has a level B recommendation. We think this may have some anti-inflammatory properties. Some people do get gastrointestinal (GI) side effects with that, so you do have to watch out. We don't recommend this one during pregnancy because it can cause early contractions and potentially miscarriage. The daily dosing for that is 50-300 mg.

Pace: It's great that there are so many different nutraceutical options for migraine prevention. I personally find the combination of magnesium and riboflavin to be a good one that I tend to start with. I think nutraceuticals come up quite often. I have many patients who ask me about them. Are there any patients, in particular, whom you think would benefit most from nutraceuticals?

Zhang: Similar to what we talked about before, many of our patients just don't tolerate some of the pharmaceutical treatments that we have, so this would be a good option to start with. One thing I always ask my patients to keep in mind is that the improvement can be gradual with these supplements. Really, like any preventive treatment, you want to give it up to 3 months before someone may see maximum benefit.

Pace: Agreed. I think it's hard sometimes to wait that long, but when they do, it really can help. Another type of CIM treatment that has really great evidence in migraine prevention includes the behavioral therapies, which brings to mind things like cognitive-behavioral therapy. I'm curious what your thoughts are about those and whether or not you recommend patients to utilize them?

Zhang: I think those are terrific options. Honestly, I think one of the challenges for providers is how to broach this topic without making your patients feel like you're dismissing their experience as psychiatric or psychological. I think one way to approach this is to help your patients understand that the contributors to their headaches are usually partial and additive, and that things like stress, anxiety, and mood disorders can have a significant impact on their headaches.

That's why it's really important that we find effective ways to address those. What's great is that now we have the highest level of evidence showing that specific biobehavioral treatments, such as cognitive-behavioral therapy, biofeedback, and relaxation training, are all effective preventive treatments for migraine.

Pace: As far as I understand, it sounds like patients who have migraine and who may also have anxiety and depression may benefit from these. Do you ever see patients who don't have a history of anxiety or depression utilize any of these therapies and find them helpful just for migraine?

Zhang: Absolutely. I would say relaxation training and also biofeedback. These are great because you can not only use them as a preventive treatment things that you practice on a daily basis for prevention but also reach for them as acute treatment tools when you feel that migraine escalating or the onset of migraine.

Pace: I think that sounds great, and I agree. I find that sometimes broaching this topic with patients can be a bit challenging because on the one hand, you want to be able to validate their experience, but at the same time help to target some of the potential mood components of their presentation or the anxiety that comes with having a migraine attack with aura, which I see very commonly and I'm sure you probably do as well. Using things like relaxation therapy in the moment during an aura, I think, can be incredibly useful.

One of the other things that I always get asked about is acupuncture and whether or not there is evidence for that in terms of its efficacy in helping with migraine prevention. I seem to get that question from many of my pregnant patients. Do you have any experience recommending acupuncture to patients? What do you think about the data for that?

Zhang: We are very data-driven and we want to provide evidence-based treatments for our patients. Acupuncture has pretty good evidence for its use as a preventive treatment in episodic migraine. There's still sparse evidence for using it to treat chronic migraine or to use it as an acute treatment.

When it comes to treating episodic migraine with acupuncture, there's an excellent 2016 Cochrane review that nicely summarizes the evidence for acupuncture for this treatment. They looked at 22 trials with almost 5000 patients and found that acupuncture is slightly more effective than sham in reducing frequency of headaches and at least similarly effective as some of our standard prophylactic medications.

Pace: That's great. As far as I know about the data, it seems like it would be a good option in addition to, perhaps, the traditional therapies that we are using, like oral medications. Similarly, yoga also comes up in the same conversation whether yoga can be useful. Again, many of my pregnant patients ask this question. Do you ever recommend yoga to patients?

Zhang: With yoga, I think there's still much we have to learn about in terms of how it helps our patients with migraine. At this time, we just don't have that much robust evidence for that.

There was a randomized clinical trial published in Neurology in 2020 that looked at the effect of yoga as an add-on therapy for episodic migraine. They had two groups. One was a medical therapy group, and the other underwent medical therapy for migraine treatment, as well as yoga. They had the yoga group practice a predesigned yoga intervention 3 days per week for 1 month with an instructor at a center. This was followed by, I think, 5 days per week for 2 months at home. They looked at over 100 patients for this study.

In the end, when they compared the medical therapy group with the yoga group, the yoga group showed a significant decrease in headache frequency, intensity, and some of the migraine disability scores. The conclusion was that yoga, as an add-on therapy for episodic migraine, may be superior to medical therapy alone. I think this is a very promising beginning in terms of the research, and I really hope that we get more studies like this done in the future.

Pace: Yes. I think it illustrates an important concept that I think many of us ascribe to, in that it's really important to think about the patient, what their lifestyle is like, and what they feel comfortable with in terms of a treatment regimen and how important it is to really create an individualized plan for them.

I personally use, often, a combination of pharmacologic treatment and nonpharmacologic treatments, so the fact that that study showed that yoga was great in addition to traditional migraine therapy hammers that point home for me, in terms of using even some of the other therapies that we've talked about in addition to our traditional oral or injectable therapies for migraine. Would you agree?

Zhang: I totally agree, Dr Pace. I think some of the most helpful treatment plans that we develop for our patients are those that integrate both pharmacologic tools and the nonpharmacologic tools that we have. Part of why I love headache medicine is that we actually get to personalize these treatments for our patients.

Pace: I completely agree. I think that's a good place for us to end. We thank you all very much for joining us.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube

More:
Complementary and Integrative Medicine for Migraine - Medscape

Arwen Podesta, MD: I'm a psychiatrist. I specialize in a whole slew of things: holistic integrative medicine, addiction medicine, forensic psychiatry, adult general psychiatry. I love using all tools in the toolbox. I want my patients to use something that is available to them 24/7. I want my patients to have therapy available, and it just hasn't been, especially with closures and people stepping back and not having live visits through the pandemic. I have adopted using prescription digital therapeutics for both my practice in the field of addiction and sleep. Everyone has sleep issues. Everyone wants a medicine for sleep. I use things that have very few-to-no adverse events, and most medications have an adverse event that could be possible.

I have used reSET, which is addiction cognitive behavioral therapy and contingency management app. I've used that in my practice for a while, as well as reSET-O, which is the same but is FDA approved for those with opioid use disorderspecifically those on a medication-assisted treatment for opioid use disorder; an example is buprenorphine. There is 12-week cognitive behavioral therapy on your app. It's about an hour a week per patient. I look at my clinician dashboard and keep up with what the patient's doing, see how they're progressing, see their pressure points and relapse potentials, and then orient my treatment accordingly. This is great because 90% of relapses don't occur when they're leaving my office. They [can] feel great then, but I'm [not] seeing them every day and not even every week, necessarily. Most relapses occur when stress happens, when people are not able to sleep, so their brain is going back to the easiest path of least resistance: going and getting that drug. Most relapses happen outside clinic hours, so they are able to use this tool on their device 24/7.

With addiction, we need treatment on demand. If someone has to wait to get into therapy, then their addiction is probably going to make rationalized excuses as to why they shouldn't go and should continue to use. Often, we mistreat on demand and when we don't have something like a 24/7 digital therapeutic. I don't know many sponsors that are going to be available at 2 A.M. every morning. [Because I use reSET and reSET-O,] I was oriented to PSM [propriospinal myoclonus at sleep onset] risk, which is a cognitive behavioral therapy for insomnia. It is wildly successful and has a different type of cognitive-behavioral therapy that is very specific and oriented for insomnia. It's been used by the VA [US Veterans Affairs Department] for [years, as well as] sleep specialists that are trained in it, but it is [programmed] for those that use this FDA-authorized prescription digital therapeutic.

What are some challenges that I've had with getting patients to buy in? First, patients are on their phone frequently, but a lot of my patients in psychiatry and addiction feel that when I'm speaking about phone use, theyre judged. They feel like [using the] phone is bad and that I'm going to want them to be off of their device. That's not true. I use motivational interviewing to discuss everything new with patients, and that's what I do for discussing prescription digital therapeutics. How long are they going to have to use it? How many hours a day? What's required? What's interesting about reSET & reSET-O? Is it also contingency management? When patients get onboarded, which is a super easy process, they get a gift card depending on the prescriber. That makes it more salient, so the patient wants to use it more. They also get a prize at random times when they finish certain modules, so there's that for those two therapeutics.

Most of my patients want a quick fix for sleep. It might take 12 weeks before theyve improved their sleep, but it usually takes much less than that. I use different types of non-scheduled medication to help them get sleep [immediately, as well as] supplements and other tools, and then use the app in tandem. Ive had several CEOs, attorneys, etc, come to me for sleep issues that know they're smart and have read about sleep hygiene, but then a particular module just got them. I get to see it on the clinician dashboard. I see that in module 2, she went from poor sleep efficacy to much higher. I ask her how that feels, how it's sustainable, and bring that to the therapeutic alignment.

There have been some barriers in adopting and adapting with PDTs [prescription digital therapeutics]. Theres a concern as far as how we're going to get this paid for. There's some attention deficitprescription digital therapeutics for kids that I know some parents are apt to pay out of pocket for because they work well. [Paying out of pocket is] not [common for] every patient. Most of this is based on some sort of cognitive-behavioral therapy, and payers tend to pay for therapy but not algorithmize therapy through a prescription digital therapeutic at this time. [Both payers and prescribers are barriers.] This can't be prescribed by a therapist or nutritionist. It can't be prescribed by a nurse. It must be prescribed by someone who has their license to prescribe medications. What do prescribers know about PDTs? When I've brought this to message boards and ask, What does everyone feel about a prescription digital therapeutic? something like 6080% of the physicians and psychiatrists responded {~100 people], said they don't know enough about them.

Trainings are essential. This started in 2016; it's new, and if we don't learn it in medical school, we're not going to use it in our practice unless we get access to it or hear success stories. If we don't have a mentor during medical school or residency that is teaching us, we're not going to use it. To have adoption of PDTs, we need great messaging with the prescribers but to also let the patients lead the way. We're at the beginning of the wave, and we've got some more education to do.

This transcript has been edited for clarity.

See the rest here:
Successes and Challenges With Using PDTs - AJMC.com Managed Markets Network