1. Clinical Protocols David B. Wood, ND B.Sc. Microbiology, University of Washington, 1977 N.D., Bastyr University, 1983 Cofounder, President: Trinity Family Health Clinic, PS, 1984 Cofounder, Vice President, CMO: BioGenesis Nutraceuticals, Inc., 2000

2. Introduction In this lecture I will review my thoughts in terms of physical exam, laboratory and therapeutic options for various conditions I see in my office. I will discuss the why’s and dosage’s of nutraceutical and botanical Rx options This lecture is not meant to be inclusive but rather a primer to encourage thought and discussion as well as an aide in your own decision making process.

3. Allergies (Food) R/O with laboratory testing (IgG) or Elimination/Challenge diet. This is a good time to do the BioCleanse Detox program. Avoid 2+ or higher foods, Rotate others Desensitise with homeopathic dilutions of allergens (Apex) or T cell balance with Sterol 117 (1-2 QD) Run Digestive/Microbiol/P testing, Organix or Lactulose/Mannitol testing to assess level of gut dysbiosis, permeability and/or digestive enzyme deficiencies

4. Allergies (Food) Remove any bowel pathogens with ParaBiotic Plus (2 TID) Consider reforestation of bowel: ProFlora Plus (2 BID). Initiate this treatment after completing ParaBiotic Plus phase. Repair mucosal barrier/gut lining with: Intestinal Repair Complex (1 tsp BID-TID) or Intestinal Repair Capsules (2-3 TID)

5. Allergies (Environmental) Seasonal? –Late February to Mid April? Probably Deciduous Tree Pollens –Mid April to Mid July? Probably Grass/Weed pollens –Year around? Probably dust mite or mold allergy Evaluate symptomatically or allergy test with IgE serum testing or skin testing.

6. Allergies (Environmental) Reduce exposure (air cleaners, electrostatic precipitators, etc.) Desensitise with Sterol 117 (T-cell balancing) (1-2 QD) Rx: BioAllergy Plus capsules (2-4 caps TID - QID between meals) Rx: Immune Balancing Complex (T cell balancing) (1-2 BID with food)

7. Adrenal Insufficiency Check for postural hypotension (Lying to standing blood pressure evaluation). I consider it significant if the systolic pressure drops by 8 points or more. Serum Sodium less than 140. My optimal is 140-142 Test Salivary Hormones to check for deficiency and/or circadian rhythm disturbances. Fatigue after exercise and history of slow recovery. Takes 2-3 days to recover from stress, exercise, etc.

8. Courtesy of Felix Grissom, PhD. Paper entitled “The Adrenal Gland”

9. 22 15 10 0 8am124 8pm 12 Ideal Adrenal Circadian Rhythm * * * * Abnormal Serum/Saliva Cortisol Readings *

10. Adrenal Insufficiency Rx:BioAdaptogen 1-2 capsules up to TID between meals Rx:BioAdreno 2 with breakfast and 1 with lunch. Do not give later in the day. Rx: Adreno Support Plus 2 BID (contains DHEA, Pregnenolone) Rx:Celtic salt to replace regular table salt (to taste) Rx:Adreno HS-SOD 2-4 capsules before bed to enhance HPA axis regulation and reduce excess evening cortisol Rx:Zone balanced regular meals. UltraLean (powder and bars) or UltraPure Whey protein to assist (1SVG/day) Rx:Stress reduction, gentle exercise

11. Anti-Aging/Longevity AGEx (2 BID) for antiglycation, antilipofuscin and antioxidant cellular protection Oxy ATP (1-2 BID) MultiGreens (2 BID) Work on low glycemic diet, exercise, stress reduction, hormone balancing, optimize immune system, digestive and elimination support, dental and intestinal hygiene, detoxification. Cardio evaluation and treatment. Cancer prevention and screening.

12. Arthritis R/O DJD vs. RA –exam –family history Zone Balanced Diet Osteoarthritis w/Heberden’s nodes Gouty Arthritis Rheumatoid Arthritis w/Bouchard’s nodes

13. Arthritis Rx: X –ArthroGen X capsules (2-3 TID with meals) X –ArthroGen X cream (topical BID – TID) –PainX capsules (2-4 BID-TID) –BioInflammatory Plus Functional Food (1 Svg/day) –EPA/DHA (2-3 BID with meals) –OsteoGenesis regular or E.S. (2 TID with meals) Labs recommended: –Organix or Digestive/Microbiol/Parasite –Allergy evaluation (Elimination/Challenge, IgG) –Urine/Saliva pH screen (r/o acidosis) –serum autoantibodies (if unsure)

14. Autoimmune Disorders Run labs to further assess patients nutritional needs: –Organix (MM) or MAP (GSDL) –Allergy (IgG or Elimination/Challenge) –Zinc Tally taste test –Postural Hypotention Adrenal Insufficiency Screen –urine/saliva pH Correct Dysbiosis –(ParaBiotic Plus, ProFlora Plus, Intestinal Repair Complex) ParaBiotic Plus and IRC can be given together. ProFlora Plus caps should be started after completing the prescribed course of ParaBiotic Plus or given for 1-2 months past completion of ParaBiotic Plus

15. Autoimmune Disorders Treat T Helper 1/T Helper 2 cell imbalance: –(Sterol 117 (1-2 QD), Immune Balancing Complex (1-2 BID) ) – Quench Inflammatory Mediators and assist in balancing Phase 1/Phase 2 detoxification pathways: X –(BioInflammatory Plus Functional Food, BioInflammatory Plus capsules, ArthroGen X, PainX, EPA/DHA)

16. Breast Disorders CRT (Computerized Regulation Thermography) testing to further define breast cancer risk Evaluate 2OH E1/16alphaOH E1 ratio (risk factor) Breast exam Mammogram/Breast Ultra Sound/Biopsy (if warranted)

17. In Breast Cancer often the lump will be attached to the chest wall Look for dimpling of the skin (retraction of skin on bending forward) Color changes of the overlying skin

18. Breast Disorders Hormone balancing: often reduction of estrogen dominance symptoms. –BioCleanse powder detox for 2 weeks followed by ongoing use of BioCleanse caps (Calcium D-Glucarate, Broccoli extract) (2 BID to TID) (Glucuronidation, Aromatase) –BioIsoflavone caps (Soy Isoflavones) –DIM PRO PLUS (FIT) (1 BID) (Aromatase) –EPA/DHA (2-3 BID with meals) –Lipopure Progesterone especially if patient also has PMS, uterine cramping, and/or heavy prolonged menses (dosage varies, 5-20 gtts BID topical (rotate sites) or oral)

19. CFIDS R/O the basics: anemia, clinical or subclinical hypothyroid (labs + temps), hypoglycemia, circadian rhythm disorders (sleep/melatonin, adrenal hormones/postural hypotension), deficient mitochondrial energy production, chronic virus (EBV, CMV), pleomorphic organism (Chlamydia pneumoniae, Mycoplasma fermentens), intestinal dysbiosis, allergy/leaky gut, T Helper 1/T Helper 2 imbalance, depression.

20. CFIDS Clean up the diet (Zone balanced whole foods) and establish a routine –often patient eats on the run. Eats fast food. Doesn’t eat on a schedule Rx: depending on findings –Possible use of: (BioCleanse Functional Food, BioAdreno, Adrenal Support Plus, BioAdaptogen, RiboZest, Lipopure Melatonin, GlucoTone, MycoPotent Immune Complex, Immune Balancing Complex, ParaBiotic Plus, ProFlora Plus, UltraHematinic, Sterol 117)

21. Cholesterol/Triglyceride Elevation Cardiovascular Occlusion Diet: Low fat, high fiber. Zone balanced. Whole foods. Variety of fresh fruits/vegetables. Exercise: 3-5 x/week combination cardio/weights. Duration/intensity according to doctors instructions Labs: VAP (Lipid panel with LDL particle size and lipoprotein (a)), Fibrinogen, Homocysteine, Cardio CRP, cIMT (carotid ultrasound intimal thickness), EBT (Electron Beam Tomography) to rule out pathologic calcification of the arteries), Nanobacterial serology, C. pneumoniae serology.

23. Cholesterol/Triglyceride Elevation Cardiovascular Occlusion Rx’s: General: BioLipotrol (2 TID) or (3 BID) lower dosage if mild elevation. Garlic 7000 (1-2 BID) Functional Food (if needed): BioCleanse or UltraLean (meal replacement) Cardiovascular Occlusion: Cardio Complete (5 – 10 QD-BID) Liposomal EDTA (2 tsp twice weekly to once daily)

24. Cognitive Dysfunction Patient complains of Simple Memory disorder (short term) Zone balance diet to protect against hypoglycemic short term memory loss CogniFactors (1-2 capsules BID) BioFocus (1 SVG/day) Ginkgo Select 120mg (1 BID) Contraindicated if patient is on anticoagulant Tx. (Coumadin/Warfarin) AD brain, Red = areas of degeneration

25. Cognitive Dysfunction EPA/DHA (2-3 BID with meals) R/O anemia, hypothyroid, elev. Homocysteine, atherosclerosis (lipid panel) Anemia:UltraHematinic (1 TID with meals) Hypothyroid: BioThyro or MetabolStim (vegetarian) 2 caps QD-BID without food and possible Rx natural ‘Armour’ thyroid medication Homocysteine: Ultra B Complex 1-2 QD with meals Elevated Lipids: BioLipotrol 2-3 BID to TID with meals

26. Colon Disorders (IBS, Colitis, Crohn’s) Labs: Organix (urine) or Digestive/Microbiol/Parasite (stool) Allergy (IgG and/or Elimination/Challenge) Hemocult (if DMSP above not done) Colonoscopy (if indicated)

27. Colon Disorders (IBS, Colitis, Crohn’s Physical Exam: Remember to perform Auscultation, Palpation and Percusstion of the abdomen AND check for referred pain from other locations (back –see dermatome chart, Upper GI (stomach, liver/gallbladder, pancreas), lower pelvic organs, valves (pyloric, ileocecal), appendix, etc.

28. Colon Disorders (IBS, Colitis, Crohn’s Rx: Intestinal Repair Complex powder or capsules – (1tsp BID to TID or 2-3 capsules BID-TID) Intestinal Rejuvenex – (2 scoops QD to BID) Vitamin E 400 1-2 QD to TID (high levels can be used to enhance SIgA production in patients with low levels. Also Dr. Bastyr recommended to stop bleeding within 4 days!) UltaPure Whey protein - 1-2 SVG/day (if tolerant to Whey) good source of glutamine and very high in immunoglobulins Ultra Fiber Plus (1 svg/day)

29. Detoxification (Heavy Metals) Assessment: Urine/Blood Toxi HMF Challenge or Hair Elements Analysis. HCA (www.holisticprotocols.org)www.holisticprotocols.org indications of environmental or drug toxicity. In office screens – high probability score on multisymptom questionaire or S.O.S. questionaire. Typical Rx’s: –Liposomal EDTA 2 tsp 2 times per week to once daily –Toxi HMF 2-3 capsules BID w/o food –BioCleanse Functional Food: – follow BioCleanse diet/dosage recommendations in handout or ½ to 1 SVG/day for longer duration of time (1-3 months)

30. Detoxification (Heavy Metals) Rx’s continued: –BioAlkalizer 1 –2 tsps daily (Green food chelator) –UltraPure Whey protein: 1 SVG/day (Glutathione and Metallothionine production)

31. Detoxification (Heavy Metals) –Possible dysbiosis treatment, intestinal reforestation and intestinal repair (ParaBiotic Plus, Dysbioplex FNG, ProFlora Plus caps, Intestinal Repair Complex) –Encourage exercise, pure water to hydration, adequate sleep, blood sugar balance through regular balanced (40/30/30), organic food based meals and stress reduction (prayer, meditation, Heart Math, etc.)

32. Fibromyalgia R/O conditions such as: acidosis (urine/saliva pH), allergies, blood sugar dysregulation, electrolyte imbalance (serum, calf cramp challenge testing), EFA deficiencies (repetitive stress muscle test), infection (approx. 50% or our patients show + to CMV), soft tissue calcification

33. Fibromyalgia Dx requires 11+/18 tender points These points are for diagnosis. Your patient may have many other tender points! Note degree of pain - mild, moderate or severe Monitor at each visit to note progress.

34. Fibromyalgia Most common Rx’d supplements: –Rx: Super FMS(1-2 per meal) –Rx: PainX (2-4 caps BID – TID) –Rx: Muscle Aid(1/2 to 1 teaspoon twice daily) –Rx: BioInflammatory Plus Functional Food (1 SVG/day) and encourage a zone balanced diet –Rx: OsteoGeneis ES (1-2 per meal) (if serum calcium less than 9.0, and calf cramp test less than 200 (goal 200-240 with no cramp) –Rx: EPA/DHA (2-3 twice daily with food)

35. GERD R/O: hypo/hyperchlorhydria, Helicobacter pylori, food allergy If acids aggravate: Avoid (vinegar, caffeine (coffee, chocolate, colas, black teas), tomatoes, citrus, alcohol, spicy foods, high fat foods) If acids ameliorate: Encourage –apple cider vinegar (1 tsp in glass of water with meals) to aide digestion

36. GERD Fiber provides bulk and weight in the stomach to help reduce reflux Rx: Ultra Fiber Plus 1-2 Svg per day

37. GERD Rx: Gastric Repair Complex (chew or swallow) 2 capsules with meals and before bed (contains Mastic Gum – supports H. pylori eradication) Intestinal Repair Complex 1 tsp BID to TID Para Biotic Plus (if extra help needed for + H. pylori) 2-3 TID for 1 month followed by: Proflora Plus 2 BID for 2-3 months

38. Headaches Diet: Hypoallergenic, zone balanced Exercise: 3-5 x/week, combination cardio/weights Rx’s: Muscle Tension: Muscle Aid (1 tsp BID) or Tri Mag (1 BID with meals, according to bowel tolerance) X Pain X 2-3 PRN OsteoGenesis ES (2 TID with meals)

39. Headaches Migraine/vascular: Ultra MigraClear Ultra (1 TID) X Pain X (3-4 TID) PRN OxyATP (1 TID) EPA/DHA (2-3 BID) Sinus Headache: BioAllergy Plus (2 QID between meals and before bed) X Pain X (2 QID) PRN NAC (MM) (1-2 BID between meals) Euphorbium (Heel) or QC (Th) nasal spray Nasal rinse with ProFlora Plus caps

40. Heart Disorders Cardiac Arrhythmia: UltraCardio (2 BID-TID with meals) Secondary Support: Muscle Aid (1 tsp BID) Taurine (MM) (1-2 BID) EPA/DHA (2 BID) Vitamin E 400 (1-2 QD with a meal) OxyATP (mitochondrial support) (1 BID with meals)

41. Heart Disorders Mitral Valve Prolapse: TriMag (1 per meal) Hypertension: Cardio HTN (1-2 caps BID) Garlic 7000 (1 TID with meals) TriMag (1 TID with meals according to bowel tolerance) OsteoGenesis ES (2 TID with meals)

42. Heart Disorders Cardiac weakness/fatigue (myopathy, CHF) –UltraCardio (2 TID) –RiboZest (1 tsp BID) In cardiomyopathy r/o viral etiology and treat if (+) In CHF diuretics may also be necessary

43. Herpes/Viral Infection Diet: Low sugar, low arginine, high lysine. Reduce intake of peanuts and chocolate Rx: LarreaRx (UpLife) 1-2 caps BID LarreaRx (UpLife) Lotion (topical) or LarreaRx penetrating Spray (topical) TID

44. Immune Enhancement Diet: Low in sugar, hypoallergenic, zone balanced Exercise: 3-5 x/week. Combination cardio/weights Stress reduction: set goals, prioritize, prayer, meditation, good sleep and eating habits, work on communication skills, organize Possible Rx’s: Lipopure Melatonin oral drops (enhancement of thymus & sleep cycle) –10-30 drops sublingually before bed nightly

45. Immune Enhancement MycoPotent Immune Complex (20-30 gtts QD) Immune Balancing Complex (2 caps BID) ImmunoGlucan (UpLife) (1-2 BID) Currently sick?: BioPotent C (2 caps BID) ImmunoGalactans (1/2 –1 tsp QD) PhytoImmune (3-4 TID) viral ParaBiotic Plus (2-3 TID) bacterial/fungal

46. Menopause/Perimenopause Zone balanced hypoallergenic diet Cardiovascular protection: –Ultra CoQ10 100 1 QD, OxyATP 1 QD, Vitamin E 400 1 QD with meals Bone loss protection: –OsteoGenesis or OsteoGenesis ES Labs: Bone Loss Resorption (NTx urine), DEXA scan Natural HRT: Lipopure Progesterone 15-30 gtts BID (oral or topical) BioIsoflavone 1 BID - TID or BioFem HRT 1 BID - TID Lab: Estronex 2OHE1/16  OHE1 (urine), salivary or serum Est/Progest and FSH

47. Osteopenia/Osteoporosis Labs: Bone Resorption (N-Telopeptide) (urine), Bone density (Dexa Scan) Weight bearing exercise HRT (if indicated: low or menopausal) –Lipopure Progesterone 15-30 gtts BID (osteoblast enhancement) –BioIsoflavone 1-2 BID (osteoblast enhancement, osteoclast inhibition) Soluble minerals and bone specific collagen for remineralization/remodeling of bone matrix –OsteoGenesis (2-3 TID) or OsteoGenesis ES (2-3 TID) does not contain MCHC –Vitamin D3 1000 (1-2 QD) UltraGest (if low stomach acid) 1-2 TID mid to end of meals UltraLean Functional Food (if overweight or needs help in improving protein intake)

48. Osteopenia/Osteoporosis Botanicals –Horsetail 2-3 capsules BID. Rich in bone and connective tissue building silicon –Nettles 2-3 capsules BID. Rich in Magnesium and silicon.

49. Premenstrual Syndrome Diet: Zone Balanced, hypoallergenic, low in sugar, caffeine Evaluate hormone status: (often a progesterone deficiency) BioFem PMS 2-3 caps TID –BID (days 11-25, occ to day 3 of cycle) Lipopure Progesterone 15 gtts BID days 11 - 25. Depending on the severity of the PMS, I may have patient start earlier than day 11. Other common Rx’s: StressX (1-2 PRN, QD – QID) for mood stability, and healthy sleep enhancement Ultra B Complex 1-2 BID (coenzyme form for greater biological activity) TriMag 1-2 BID UltraLean Functional Food 1 SVG/day

50. Prostate Disorders PSA laboratory testing. Blood draw before digital exam Physical exam of gland (DRE) Benign: Rx BioInflammatory Plus Functional Food for 2-3 weeks to detox and determine any possible food intolerences BioProstate 1-3 BID EPA/DHA 2-3 BID Sterol 117 1-2 QD Vitamin D3 1000 1-2 BID

52. Prostate Disorders Rx: Malignant: Above recommendations as well as: –Proteolytic enzymes: BioPan or Vegizyme – Immune enhancers: MycoPotent Immune Complex and Immune Balancing Complex, ImmunoGalactans, Pulsed antioxidants (if on chemotx or radiotx treatment) OxyATP, Green Tea, BioPotent C, MultiGreens –Anti-metastatic agents: Fractionated Pectin (Th), Turmeric (Curcumin) such as: BioInflammatory capsules

53. Further Information BioGenesis Nutraceuticals, Inc. –1.866.272.0500 David B. Wood, ND –425.778.5673 –dwoodnd@trinityclinic.com –dwoodnd@bio-genesis.com