Forty years ago, the US Surgeon General declared that we had “won the war on infectious disease.” Unfortunately, we now know this assessment was inaccurate. Infectious disease remains a substantial heath challenge today, even in the industrialized world.
Not only have new infectious diseases appeared since the 1970s (e.g., HIV, avian flu, Ebola, to name a few), mutations in common pathogens have renewed centuries-old challenges to the human immune system. Drug-resistant germs keep us busy finding new ways to fight pneumonia, tuberculosis and other potentially deadly diseases. Natural disaster, such as last year’s earthquake in Haiti or the massive floods in Pakistan, create breeding grounds for dreaded diseases such as cholera.
Today’s clinicians are faced with a plethora of pathogens that need to be understood, identified, and treated: common yeast and urinary tract infections, chronic hepatitis B and C, antibiotic-resistant Clostridium difficile, Helicobacter pylori, Lyme disease, and Klebsiella, are just a few of the most common.
Beyond acute infections, we also know that infectious pathogens play a role in many chronic conditions such as cardiovascular disease, some cancers, autoimmune diseases such as rheumatoid arthritis and ankylosing spondylitis, digestive disorders such as IBD and IBS, and neurodegenerative disorders such as multiple sclerosis.
It is absolutely critical, therefore, that healthcare professionals examine and understand not only what to do when someone has an infectious illness, but also how to help patients avoid becoming sick. This responsibility forces us to focus on a bigger picture, one that includes the host’s relationship to microorganisms, inherent and acquired susceptibilities, barrier effects, and immune defense mechanisms.
The Importance of Terrain
The overt manifestations of an infectious disorder---the symptoms that drive an individual to seek care—are not simply a consequence of being exposed to a pathogen. Disease arises when there is a fertile ground in which infectious pathogens can thrive. This fertile ground is a net result of a continuous and complex interplay between an individual’s environment, lifestyle, and genetic profile. It is not enough simply to blast microbes with antibiotics; we need to understand how and why people become susceptible to particular infections.
The Challenge of Emerging Infections in the 21st Century: Terrain, Tolerance, and Susceptibility, the Institute for Functional Medicine’s 2011 International Symposium, to be held April 28-30, 2011, at the Hyatt Regency in Bellevue, WA, is all about cracking the code of how susceptibility to infection or dysfunction is created.
Our inner physiological “terrain” or body ecology is actually a microbiome consisting of 10 trillion animal cells and 100 trillion microbes living within and on us. The nature of the microbes, and the balance between them, can powerfully influence susceptibility to disease.
“It is clear that pathogenic bugs, with their rapid lifespan, hardiness, and mutability, are well positioned to ‘out-evolve’ us. So, while a focus on the bug is important, a broader focus on the terrain is critical,” says Dan Lukaczer, ND, Senior Associate Director of Medical Education, and IFM’s lead organizer for this year’s Symposium.
Do PPIs Induce Infections?
The alarming emergence of Clostridium difficile represents one example of how an aberration in terrain can lead to an increased risk of infection. C. difficile is a species of Gram-positive bacteria that can cause severe diarrhea and other intestinal disease, most commonly when other gut bacteria are decreased by antibiotic administration (visit www.holisticprimarycare.net and read Clostridium difficile: How Worried Should We Be? from HPC’s Summer 2010 edition).
Three million Americans each year are afflicted with C. difficile; however, only one third of people who carry the bug actually develop an active infection. Why do some get ill while others don’t? One reason appears to be the increasing use of proton pump inhibitors (PPIs), now available over the counter.
Two recent studies, both published in the Archives of Internal Medicine, strongly support this connection. In a large prospective trial, data from more than 100,000 patients over five years showed that those who used PPIs more than once daily were more than twice as likely to develop a C. difficile infection (Howell MD, et al. Arch Intern Med. 2010;170:784-90).
The second study looked at PPI use during C. difficile treatment. Among 1,166 patients treated with metronidazole or vancomycin, there was a 42% increased risk of recurrence among those patients who were concurrently on a PPI (Linsky A, et al. Arch Intern Med. 2010;170(9):772-8). Given the vast number of people taking PPIs, this is an issue of great clinical significance, one of many to be explored at the IFM Symposium.
A Unique Education Opportunity
Experts from around the world will share evidence-based approaches to improving prevention and management of chronic and emerging infections, explore points of leverage to modify the immune response, review the most appropriate laboratory assessments to diagnose underlying chronic infections, and offer clinical tools and integrative treatment options (e.g., diet, supplements, pharmaceuticals, botanical medicines) to strengthen and support immune system health.
Topics to be explored include: antibiotic resistance, Small Intestinal Bacterial Overgrowth (SIBO), chronic pediatric infections, testing for intestinal parasites, dental and intestinal biofilms, the effects of trauma and stress, the hygiene hypothesis, and many more. The program offers special sessions devoted to C. difficile, methicillin-resistant Staphylococcus aureus (MRSA), and other specific microbes, all with a primary focus on helping clinicians view the terrain as part of their clinical solutions.
The 25 Symposium speakers include leaders in transforming cutting-edge research into appropriate clinical interventions who will share their strategies for preventing and treating infections. A few intriguing previews:
• Paul Schrekenberger, PhD, will explore the thorny issue of antibiotic resistance, MRSA, and C. difficile.
• Sandra Macfarlane, PhD, will share unique ways to alter the species composition of mucosal biofilms, and will also present a session on the most well researched and efficacious strains of prebiotics and probiotics.
• Michael Ash, DO, ND, in his talk called “Diet, Nutrient Insufficiency, and Susceptibility to Infection,” will discuss assessment and treatment options for those susceptible to repeated chronic infection.
• Joe Burrascano, MD, a world-renowned expert on Lyme Disease will take attendees through detailed assessment and treatment recommendations.
• Garth Nicolson, PhD, Charles Stratton, MD, and David Perlmutter, MD, will share clinical insights on how Mycoplasma and Chlamydophila contribute to the etiology of neurodegenerative, neurobehavioral, autoimmune, and psychiatric problems
• Ritchie Shoemaker, MD, will explain how toxins produced by pathogens may cause chronic illness long after the pathogen itself has been eradicated.
“The aim of this Symposium is to develop true personalized medicine when it comes to chronic infections—the right strategy for the right person at the right time,” said Dr. Lukaczer.
IFM: 20 Years’ Strong!
At this April’s Symposium, IFM will celebrate 20 years as the global leader in functional medicine education. Throughout the Symposium, the ACCME-accredited educational nonprofit will commemorate its history and preview its future, culminating in a gala on Saturday evening, April 30.
If you’re thinking of attending this landmark event, register early. Last year’s Symposium sold out! For full details about the Symposium as well as other opportunities for learning, please visit IFM’s website: www.functionalmedicine.org
Clinicians looking for an opportunity to delve even more deeply into the realm of infections and the immune system should consider attending IFM’s Advanced Practice Module, The Many Faces of Immune Dysregulation and Chronic Inflammation: Chronic Infections, Atopy, and Autoimmune Disorders. This course focuses on chronic inflammation and systemic influences on the immune system.
Sheila Quinn is Senior Editor & Special Projects Director at the Institute for Functional Medicine. A pioneer in the field of integrative medicine, she has held several key leadership positions, including Executive Director of the American Association of Naturopathic Physicians (1993-2000) and co-founder & Vice President of Bastyr University.
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