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GUT HEALTH AND SYSTEMIC DISEASEYour gut holds the keys to optimal health
Keith R. Holden, M.D.
FOOD SENSITIVITY & SYSTEMIC COMPLAINTS
GUT INFLAMMATION & SYSTEMIC DISEASE
Total surface area of GI tract > 200X surface area of skin
GI tract is the largest surface area where we interact with our environment
Gut immune dysregulation + excessive inflammation = systemic disease
GUT FUNCTION & AUTOIMMUNE DISEASE
Environmental triggers (food, microbes)
Genetic tendency for immune system to overreact to triggers
Intestinal hyperpermeability associated with many diseases – CD, T1DM, MS, RA, IBD
CELIAC DISEASE – CLUES FOR AUTOIMMUNITY
TRIAD 1) Environmental trigger (antigen, e.g. gluten)
2) Genetic susceptibility (HLA pattern particularly efficient at presenting antigen (gluten) to immune cells (HLA-DQ2/HLA-DQ8)
3) Intestinal hyperpermeability AKA “leaky gut” – tight junctions moderated by specific proteins
Fasano A. Sci Am. August 2009;301(2):54-61
ALESSIO FASANO, M.D.
Prof. of Pediatrics & Dir. of Ctr. for Celiac Disease Research at Univ. of Maryland School of Med.
“Together with the gut-associated lymphoid tissue and the neuro-endocrine network, the intestinal barrier, with its tight junctions, controls the equilibrium between tolerance and immunity to nonself-antigens. When the finely tuned trafficking of macromolecules is dysregulated in genetically susceptible individuals, both intestinal and extraintestinal autoimmune disorders can occur.”
HELICOBACTER PYLORI
Most common chronic bacterial inf. in the world
Present in half of world’s population Affinity for stomach mucosa Disrupts permeability of GI tract Induces a sustained immune response
(excess inflammation) May progress from gastritis to malignancy Molecular mimicry results in systemic AD
MOLECULAR MIMICRY (MISTAKEN IDENTITY)
Environmental exposure to antigens (food, microbes)
In genetically susceptible individuals induces cross-reaction with structurally similar AA motifs in tissue
CD patients have ~ 10X rate of autoimmune thyroid disease as nonceliacs reflective of gluten/gliadin Ag-Ab complexes for thyroid tissue
H. PYLORI & SYSTEMIC DISEASE
IHD CVD ITP Iron-deficiency anemia Idiopathic anterior uveitis Autoimmune thyroid disease (Graves,
Hashimotos) MALT lymphoma
BACTERIAL ASSOC. WITH SYSTEMIC DISEASE
Klebsiella penumoniae – spondyloarthritis (AS)
Yersinia enterocolitica – autoimmune thyroid dis.
Campylobacter jejuni – reactive arthritis, GBS Salmonella – reactive arthritis E. coli – HUS Candida albicans – atopic dermatitis, CD Strep pyogenes – Rheumatic Fever Chlamydia – MS Citrobacter, Klebsiella, Proteus - RA
SUMMARY
Studies are showing that the triad of (1)environmental triggers (food, microbes), (2)genetic susceptibility, and (3)intestinal hyperpermeability play a key role in the development of autoimmune and other systemic diseases through uncontrolled inflammation.
Other issues: digestion and proper assimilation of micronutrients necessary for optimal immune status; beneficial bacteria’s role in digestion and immunity; and the gut-brain axis
GUT-BRAIN AXIS
MY APPROACH
Comprehensive History & Physical
Antecedents and Triggers Detoxification Questionnaires Toxin exposure history (past and present) Signs and symptoms of micronutrient
deficiencies Signs and symptoms of “leaky gut” & dysbiosis Review of bowel habits in detail Detailed physical exam
DETAILED ORODENTAL ASSESSMENT
Plaque, amalgams, crowns, bridges (malocclusion?)
Mixed metals (galvanism)
Old root canals (notorious for infection)
TMJ (CST, chiropractor)
Tongue, gums, mucous membranes, tonsils
MEDICATION REVIEW
Culprits for “leaky gut,” micronutrient deficiencies, and microbial overgrowth:
PPI, H2 blockers, antacids NSAIDS Corticosteroids Statins (CoQ10) Antibiotics
NUTRITIONAL ASSESSMENT
Dietary review
Standard American Diet (SAD)
FM Comprehensive Elimination Diet – stress elimination of wheat/gluten, dairy, sugar, high-glycemic index foods (grains), caffeine, ETOH
ALCAT
Measures the change in WBCs in size and number after antigen exposure
Screens for reactivity to foods, additives, colorings, drugs, and molds
ALCAT AND WEIGHT LOSS
“Even when one focuses only on the changes occurred in the experimental group without comparison to the control group, the data reveal that 98 percent of the subjects following the ALCAT plan either lost scale weight or improved body composition.”
Kaats GR, Pullin DP, Parker KL. The short term efficacy of the ALCAT test of food sensitivities to facilitate changes in body composition and self-reported disease symptoms: a randomized controlled study. The Bariatrician. Spring 1996.
PRIORITY TESTING – CDSA/PARASITOLOGY
CDSA with microbial stool analysis including parasitology and H. pylori screening
Assesses for dysbiosis – imbalance of beneficial to potentially pathogenic microbes
Some assess for inflammatory markers, bile salts, HCL status, and pancreatic enzyme function
Does not assess for SIBO
5 RS OF FUNCTIONAL MEDICINE
Remove
Replace
Repair
Reinoculate
Rebalance
REMOVE (STRESSORS)
Biomechanical imbalance/subluxation
Address stress including old emotional toxins
Food sensitivities (FM CED, ALCAT)
Detoxify xenobiotics (ext. toxins) and endotoxins
Pathogenic microbes (bacteria, yeast, parasites)
REPLACE
HCL
Digestive enzymes
Bile salts
Fiber
REPAIR
Rest Vitamins (pantothenate, E, A, D, C) Activated B vitamins (pyridoxal 5 phosphate,
folinic acid/L-methylene tetrahydrofolate, methylcobalamin/adenosycobalamin)
Minerals (zinc) Support of GALT fxn (lactoferrin, whey, Ig) Antioxidants (catechins) Anti-inflammatories (curcumin,
EPA/DHA/GLA/oleic acid) Glutamine and aloe vera
REINOCULATE (BENEFICIAL FLORA)
Probiotics (Bifidobacter, Lactobacillus, S. boulardii)
Prebiotics (Inulin, FOS, Arabinogalactan)
REBALANCE
Lifestyle changes
Scheduling rest and relaxation; adequate sleep
Mindful eating
Balance autonomic nervous system
Balance brain waves
BASIC NUTRITIONAL SUPPLEMENTS
High potency MVI/MM w/aBv – Prothera MultiThera
Activated B vitamins – NeuroBiologix Neuro-Immune Stabilizer (transdermal)
Essential Fatty Acids blend (EPA/DHA 3000mg) – Natura Health Products Beyond Essential Fats
Probiotics 25-900 bil cfu (Ther-Biotic Complete, VSL#3)
Vitamin D (based on blood levels) Medical Food (Xymogen I5)
REMOVE
DFH GI MicrobX or Prothera Undecylex Parasites: BioPure Artemesinin or Mimosa Pudica Bacterial: Syntrion SyGest + SanPharma Firmus Fungal: Syntrion SyRegule + SanPharma Candida-
Roqueforti suppositories Fungal Sinus: Syntrion SyFungin & Argentyn 23 NS PEKANA Mucan, Helmin, Opsonot, Mundipur Natural Immunogenics Argentyn 23 liquid/spray Detoxification: PEKANA Basic Detoxification
& Drainage Kit (apo-Hepat, Renelix, Itires) Syntrion SyDetox for “hot liver” signs &
symptoms
TREATING H. PYLORI WITHOUT ANTIBIOTICS
OrthoMolecular Products Pyloricil (Zinc carnosine, Mastic gum, Berberine, Bismuth citrate) x 2 mos
Lactoferrin
Probiotics/Kefir
Always check H. pylori stool Ag 1 month after completion of therapy
PARASITE THERAPY
B. hominis: SMX/TMP + Metronidazole/Secnidazole
Cryptosporidia: Nitazoxanide (Alinia) Dientamoeba fragiis: Iodoquinol Enterobius Vermicularis (PW): Pyrantel Pamoate Giardia: Tinidazole/Metronidazole Entamoeba histolytica: Iodoquinol Worms: Albendazole/Mebendazole
Apothecure pharmacy – Paragone 5 and Paragone 6 (compounded combination of antiparasitics)
REPLACE
Theramedix DGX
Betaine HCL
Standard Process Cholachol
Natural Factors PGX (konjac root)
REPAIR
GI Cocktail: 1 heaping tsp of glutamine powder in ½ cup of George’s Aloe Vera juice 2-3 x day
ECGC (green tea)
Curcumin
Xymogen IgG 2000/Xymogen I5
REINOCULATE
Klaire Labs Ther-Biotic Complete (25 bil CFU)
VSL#3 (caps 112.5 bil CFU, packets 450 bil CFU, and DS packets (requires Rx) 900 bil CFU
Saccharomyces boulardii (C. difficile)
Thorne Research Arabinex
REBALANCE
Address emotional toxins - ERT, counseling, journaling, Inner Child meditation, compassionate forgiveness
Balance autonomic nervous system - acupuncture, meditation, breath work, yoga, Tai Chi, Ballroom Dancing, PEMF, Microcurrent therapy (CES), Low-level laser
SPECIALIST REFERRAL LIST
Biological/Holistic Dentist Chiropractor Acupuncturist Massage Therapist Craniosacral Therapist Eden Energy Practitioner Holistic Psychological Counselors
FINAL ADVICE
Stay open to possibilities
See the world through the eyes of a child
Embrace change
Take with you what resonates with you and leave the rest alone (what feels right)
Never stop evolving (transformation/growth)
MINDFULNESS
“Mindfulness practice means that we commit fully in each moment to be present; inviting ourselves to interface with this moment in full awareness, with the intention to embody as best we can an orientation of calmness, mindfulness, and equanimity right here and right now.”
Jon Kabat-Zinn, Wherever You Go, There You Are
ALCAT TESTCell Science Systems
852 South Military Trail
Deerfield Beach, Florida 33442
www.alcat.com