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Tracy’s health counseling certification is from Columbia U i it f th I tit t f

Take lots of notes! The more often you see these connections, the more readily you will be able to recall them in your practice.

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training and is working on a certification in understanding the root causes of chronic illness with the Institute of Functional Medicine and on an

questions on the course material itself and not detailed case study review.

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Functional Medicine and on an additional Masters degree in Human Nutrition at Bridgeport University.

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All Disease Begins in the Gut 202

Part 2

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Today’s Agenda

G.I. Roots of InflammationAutoimmune Dis-easeInflammatory Bowel DiseaseComprehensive Stool TestingCase StudiesResources for More Information

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Optimal Health is Not ComplicatedOptimal Health is Not Complicated

MaximizeP i h ’ d d f hi i Put in what’s needed for this unique person

Raw materials your body needs to function and heal Oxygen, Water, Vitamins, Minerals, Antioxidants, Protein, Healthy Fats Belief that the therapy one is choosing is effective and safe

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Belief that the therapy one is choosing is effective and safe

MinimizeTake out what’s harmful for this unique person

T i I f i All S T

Simplifying the face of health can b l i

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Toxins, Infections, Allergens, Stress, TraumaLimiting beliefs, fear, negative expectations

Prioritize

be very calmingand inspiring to

your clients.Prioritize

Create an environment for healing for this unique personSleep, Rest, Laughter, Stress ReductionExercise, Stretching, Breathing

M i f l R l i hiMeaningful RelationshipsPositive visualizations and associations

And then the body will heal itself – will naturally seek wellnessOf course we are not very good at doing these three things consistently And then the body will heal itself – will naturally seek wellness.Of course, we are not very good at doing these three things consistently. The result? Chronic Dis-ease in the body.

This is Why Your Clients and Patients Need You!

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G.I. Roots of Inflammation

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6● “Gastrointestinal Tract”

or Digestive System● ~25-30 ft in length● Many glands, cavities,

hormones● Wavelike muscle action

called peristalsis moves it● Gateway of nourishment

for every cell in the body● Primary waste disposal

route in the body● Includes an “organ” of

100,000,000,000,000 microbes

Your Best Friend?

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The Wild Frontier

● The GI tract is essentially “outside” of the body, like the hole in a doughnut.It's an exchange area where– Nutrients come in– Toxins and foreign invaders are kept out– Wastes are deposited for excretion– The body SENSES our environment

● The critical lining of all cavities in theGI tract has a vital role of separating the Good from the Bad.

● 2/3+ of our entire immune system is just below the preciousmucosal gut lining. If it is damaged, we are less well-protected.– In the stomach: gastritis or ulcers– In the intestines: malnutrition or leaky gut– In the colon: diverticulitis

● What happens in the gut affects the rest of the body!– Not just Nutrient intake/deficiency but Inflammation

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Etiology of Dis-ease in the Gut

Deficiency-Driven Dysfunction– e.g. anemia, neuropathy, depression, headache

Digestive Dis-ease– e.g. IBS, constipation, belching

GI-origin Inflammation– e.g. osteoarthritis, asthma, migraine,

chronic fatigue, fibromyalgiaAuto-immune Dis-ease

– Hashimoto's thyroiditis, lupus, multiple sclerosis, Crohn'sdisease, rheumatoid arthritis

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“The [G.I.] mucosa is directly exposed to the external environment and taxed with antigenic loads consisting of commensal bacteria, dietary antigens, and viruses at far greater quantities on a daily basis than the systemic immune system sees in a lifetime”*

99.99% of the time, the job of the immune system is to NOT respond.

* Mayer L. Mucosal Immunity. Pediatrics 2003;111:1595-1600.

Our Overworked Police Force

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Making It Simple

“There is no ‘disease’ in the body, only dis-ease. The origin is always unique – always.”

Dr. Jeffrey Bland

GENES

ILL-NESS

ENVIRONMENT:

The Good, The Bad, and the Ugly

WELL-NESS

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Inflammation (often!) Begins in the Gut

Pathogenic microbes (e.g. parasite, bacteria, yeast)– Perhaps compounded by toxins secreted by the microbes

Dysbiosis (an imbalance in indigenous, human gut bacteria OR species of bacteria in the wrong place in the gut)

Food (that looks a little too much like a toxin, allergen, or foreign invader e.g. GMO foods including 90+% of non-organic soy and corn grow in the US)

Toxins (e.g. pesticides, Red #40, birth control pills, artificial sweeteners, toothpaste, mercury, alcohol)

Clinical Tip: NSAIDs are prescribed to stop inflammation. However, they are particularly damaging to the precious lining of the stomach and intestines, potentially causing pain, digestive limitations, immune system dysfunction, AND systemic inflammation.

A great article to use to help clients to understand NSAID dangers: http://www.dailymail.co.uk/health/article-2042132/How-taking-painkillers-destroy-stomach-lining-days.html

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Etiology of Disease: In the Gut

Dysbiosis

Infection

Food sensitivities

Toxins

Inflammation Arthritis

Eczema

Asthma/Allergy

Psoriasis

Chronic Fatigue

Fibromyalgia

Chronic PND, headache, muscle pain, etc.

BUT there may be no GI symptoms whatsoever!

Tendonitis

Cancer

Atherosclerosis

Auto-immune disease

e.g. TNF-αIL-1IL-6CRPESR

Genetic Expression

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Systemic Inflammation

● Gut triggers cause the release of NF-KappaB, cellular release of cytokines, andan inflammatory cascade in the gut.

● Exposure to wide ranging microbes in childhood is important for a balancedimmune system and prevention of allergy, asthma, eczema.*– “Old Friends” vs. “Hygiene” hypotheses

● 77% of patients with a Fibromyalgia diagnosis and 92% of those with aChronic Fatigue Syndrome diagnosis test positive for SIBO**.

● 76% of patients with Restless Leg Syndrome had 80% or greater improvementin symptoms after SIBO treatment. ***

● Bifido Infantis probiotic use improves pro-inflammatory markers in patientswith psoriasis and other inflammatory disease.****

● Arthritis is a common symptom in those with gut-mediatedinflammation.*****

● Treatment requires– Eliminating the source (e.g. dysbiosis, food sensitivities, toxins)

– Reducing inflammation (e.g. antioxidants, herbs, water, exercise, whole food,essential Omega-3s/Omega-6s)

* http://www.sciencedaily.com/releases/2012/10/121003082734.htm and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448690/** Aaron, L. A., M. M. Burke, et al., Arch Intern Med 160(2): 221-7, 2000.*** http://www.ncbi.nlm.nih.gov/pubmed/17934858**** http://download.abstractcentral.com/ACG2011/proofs/P283.html ***** http://www.gidoctor.net/client_files/file/Turnbull_Chapter_Final.pdf

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Autoimmune Dis-Ease

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Etiology of Dis-ease in the Gut

Deficiency-Driven Dysfunction– e.g. anemia, neuropathy, depression, headache

Digestive Dis-ease– e.g. IBS, constipation, belching

GI-origin Inflammation– e.g. osteo arthritis, asthma, migraine,

chronic fatigue, fibromyalgiaAuto-immune Dis-ease

– Hashimoto's thyroiditis, lupus, multiple sclerosis,Crohn's disease, rheumatoid arthritis

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Autoimmune Dis-Ease

● Autoimmunity is the failure of an organismin recognizing its own constituent parts as self,which allows an immune responseagainst its own cells and tissues.

● Some small amount of autoimmunity is natural (if not helpful!).● In AI, antibodies are present for necessary, human cells (often enzymes).● Hundreds of different types...lupus, MS, RA, Sjogren's, Type 1 diabetes,

Hashimoto's, Grave's, Celiac, Crohn's...● “Regulatory T cells prevent biological “friendly fire” by ensuring that the T

cells do not attack the body's own tissues. Failure of the regulatory T cellscontrol the to frontline fighters leads to autoimmune disease”*

● Each case is unique in triggers, genetics, and predisposing factors.– Immune dysregulation (esp. in the gut mucosal layer)

– Molecular mimicry (esp. in regard to food and toxins)

– Immuno-deficiency (weak immune system, ongoing/multiple infections)

* Zheng Y, et al. Nature. 2007 22;445(7130):936-40.

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“We have no other good explanation as to why there should be an increase in autoimmune disease, except for the things to which we are exposed in our environment.Autoimmunity is our immune system's attempt to adapt to all the new environmental agents and shifts that we're being bombarded with every day. It's an unsuccessful adaptation, but it is our body's way of trying to fight back.”

Dr. Noel Rose, MD, PhDDirector, Autoimmune Research

Johns Hopkins University

http://www.ncbi.nlm.nih.gov/pubmed/16265432

Autoimmune Epidemic

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“...the autoimmune process can be arrested if the interplay between genes and environmental triggers is prevented by re-establishing intestinal barrier function....This review is timely given the increased interest in the role of a 'leaky gut' in the pathogenesis of gastrointestinal diseases and the advent of novel treatment strategies, such as the use of probiotics.”

http://www.ncbi.nlm.nih.gov/pubmed/16265432

Times, they are a'Changin'!

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Inflammatory Bowel Disease (IBD)

● Acute, auto-immune inflammation of the digestive tract itself– Generally thought to have a genetic component

● Typically includes two illnesses– Crohn's Disease: Inflammation anywhere along GI tract– Ulcerative Colitis: Inflammation of the colon/rectum specifically

● May be commonly triggered by infection/dysbiosis, food sensitivities, toxins, ora combination of these.– A comprehensive stool test can help to identify dysbiosis triggers.

– Clinical tip: pretty much anyone with IBD is going to have food sensitivities.Consider immediate gluten and dairy elimination and follow-on IgG and IgE foodantibody testing if possible. I use Designs for Health's G.I. Revive to help to heal theintestinal lining.

● Very high-dose probiotics (VSL#3) shown to be very effective for alleviating (oreliminating) symptoms*.– Equal to or better than typical common treatment mesalamine (typical IBD Rx anti-

inflammatory with known side effects: Diarrhea, Nausea, Cramping, Flatulence)*

● Natural anti-inflammatories help greatly (e.g. omega-3s 2g 2s/day, Meriva curcumin1000mg 2-3x/day, quercetin 1000mg 3x/day, boswellia 300mg 3x/day)

● Usually high need for nutrient supplementation (e.g. MVI, folate, Vitamin D ≥50 ng/ml)*** VSL#3 has 450B CFU/dose & 8 strains. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033537/**These may be of interest on the role/data of Vitamin D and AI disease. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036961/ and http://www.huffingtonpost.com/dr-mark-hyman/how-much-vitamin-d_b_796734.html

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Frank D N et al. PNAS 2007;104:13780-13785

©2007 by National Academy of Sciences

Gut Microbes in IBD

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Pulling it All Together:ComprehensiveStool Testing

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Why Stool Testing?

● Traditional stool testing– Requires a “guess” at what you are looking for to check for specific DNA.– Or stool “smear” is manually assessed under microscope

● DNA assessment yields specific numbers (vs. yes/no presence).● All at one time, check

– Predominant bacteria– Pathogenic species (I call these “foreign invaders” to my clients)

● Shows (often) resistance of foreign invaders to various Rx and herbal remedies

– Digestive enzymes, HCl, sIgA, malabsorption, SCFAs

● I use Metametrix G.I. Effects almost exclusively (available at www.mymedlab.com).Typically ~$400. Takes ~3 wks to get results. Single sample collection (3 vials). Occasionally covered by insurance (Medicare: yes)

– Other option is Genova Diagnostics Comprehensive Digestive Stool Analysis (CDSA).Offers greater detail in species identification but no total counts. Includes beta-glucuronidase (estrogen de-coupling).These two companies are merging, so I expectthe co-offered test in the future to be truly amazing.

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Predominant Bacteria● All the major families of bacteria

typically found in the human gut● Look for aggregate overt overgrowth

and undergrowth.– High fusobacterium increases

inflammation in the colon.

– Mycoplasma overgrowth is often at playin CFS and Fibromyalgia.*

– Streptococcus, Mycoplasma, andCandida are often involved in arthritis.

– Low Bifidobacteria is a common driverof constipation.

– Low Lactobacillus is sometimes a driverof loose stools.

● Bacteroides and Bifidobacteria shouldbe the highest.

● Probiotics help to counter generalimbalance.– See notes from webinar #1 for specific

recommendations.

* Nicolson, Garth, et al. Mycoplasma Infections in Chronic Illnesses: Fibromyalgia and Chronic Fatigue Syndromes,... Medical Sentinel, Vol 4, #5, 2005.

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Foreign Invaders

● Bacterial– Bacillus– Salmonella– Clostridia– Streptococcus– EHE Coli

● Yeast/Fungal

– Candida– Rhodoturola– “Unidentified”

● Parasites

– Pinworm, Ringworm– Blastocystis Hominus– Giardia

* Nicolson, Garth, et al. Mycoplasma Infections in Chronic Illnesses: Fibromyalgia and Chronic Fatigue Syndromes,... Medical Sentinel, Vol 4, #5, 2005.

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Short Chain Fatty Acids (SCFAs)

● Produced by bacteria in the mucosallayer when they ferment carbohydrateresidue, mostly soluble fiber.

● Provides food for intestinal cells. Highlevels protect against colon cancer.*

● Butyrate is believed to be the mostanti-inflammatory.*

● Very high levels (rare) may also be asign of poor digestive enzyme function(check Elastase 1)

● Higher soluble fiber in the diet willincrease SCFA– Arabinogalactins (e.g. larch gum),

Psyllium husks– Do not supplement with these until

overgrowth dysbiosis is well-on-the-way to being corrected.

* Royall, D., T.M. Wolever, and K.N. Jeejeebhoy, Clinical significance of colonic fermentation. Am J Gastroenterol, 1990. 85(10): p. 1307-12.

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Secretory IgA (sIgA)● Most abundant antibody in the gut● Secreted into the protective mucosal layer of the intestine.● Blocks microbes from getting to the boundary layer of the intestines

(epithelium) and prevent them from joining the biofilm (e.g. candida)● Highly elevated levels indicate aggressively active immune combat.

– Could be a microbe but also could be a food! Be thorough.● Low levels indicate impaired immune function.

– Anger, stress*– Chronic activation– Poor nutrient support

for immunity● What raises suppressed sIgA?

– Saccharomyces boulardi probiotic(e.g. Metagenics Spectrum, 2x/day)**

– L-glutamine powder(3 grams, 2-3x/day)

– Colostrum*** (not for thosewith dairy sensitivity)

– Omega-3 essential fats– “Immune boost” nutrients (

Vitamin D, Vitamin A, Zinc)

http://www.heartmathbenelux.com/doc/compassion-and-anger.pdf ** http://www.horizonpress.com/cimb/v/v11/47.pdf *** http://www.icnr.org/what-is-colostrum-good-for/what-is-colostrum-good-for.html This site is marketing colostrum, which I usually avoid, but the citations are really quite interesting and broad. Please forgive any sales-y commentary.

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Digestion/Absorption Markers

● Elastase 1: marker of pancreatic total digestive enzyme secretion● Putrefactive SCFAs: a marker of protein digestion (HCL deficiency

and/or protein digestive enzymes)● Vegetable fibers: marker of carbohydrate maldigestion (enzymes)● Triglycerides: marker of fat maldigestion (enzymes)● Cholesterol: marker of fat malabsorption/maldigestion (bile acids)● Long chain fatty acids: marker of fat malabsorption

– Clinical tip: high fat malabsorption is extremely common in those with parasiticinfections and is one sign of the “need to treat”. But remember to make sure yourclients have a gallbladder!

Parasitic infection No gallbladder

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Case Study: Mary

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Parasites

● Not necessarily an issue.* Some are benign; they can be transient (esp. if it isof an unknown species). Look for GI symptoms (e.g. pain, cramping, nausea,diarrhea/loose stools) or other systemic inflammation (e.g. joint pain, headaches,depression). But presumably your client was doing a stool test in pursuit ofanswers to inflammatory issues.– Clinical tip: often, I see yeast and parasite go hand-in-hand in a stool test. Yeast can

secrete chemicals that make it easier for parasites to thrive. When you see both, Irecommend you try to help the client get rid of yeast first.

● If necessary, boost the immune system (Vitamin D, Vitamin A, zinc).● Probiotics (can start immediately). Use full-spectrum blend, unless other is

indicated due to symptoms (e.g. loose stools).● Antiparasitic herbs such as garlic, wormwood, capryllic acid, undecylenic acid,

black walnut hull. I use two courses of Renew Life “ParaGone” cleanse –separated by 10-12 days (to get life cycle stages). Many herbs you will use torebalance bacteria or counter yeast are also effective against parasites.

● When herbs don't bring relief (or retest still shows parasite), there areprescriptions available (e.g. metronidazole or Flagyl) which are pretty strongantibiotics.

● Identify and Eliminate Food Sensitivities● Healing the Gut steps as in the first webinar for SIBO.

* “An interesting look at how worms can actually be beneficial:http://blogs.scientificamerican.com/observations/2012/11/15/parasitic-worm-eggs-ease-intestinal-ills-by-changing-gut-macrobiota/

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Case Study: Dina

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Gut Healing 5Rs

● Order of operations is important– Remove first – always! (e.g. harmful microbes,

allergen/sensitivity foods, foods that feed undesired microbes)

– Replace (e.g. digestive enzymes, stomach acid support, bile acids,herbal remedies to boost immune system insufficiency)

– Reinnoculate (probiotics)

– Repair (villi regeneration, nurturing mucosal layer, increasingSCFA (e.g. butyrate) with larch gum or other fiber additions)

– Rebalance (stress relief, long-term diet changes, attitude)

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More Information

● A detailed yet simple article explaining autoimmune diseases and why they occur (good for clients):http://www.aarda.org/infocus_article.php?ID=28

● An excellent book about the key triggers behind the epidemic of autoimmune diseases:“The Autoimmune Epidemic” by Donna Jackson Nakazawa, Simon & Schuster, 2008.

● Additional support for interpreting the Metametrix GI Effects stool profile:http://www.metametrix.com/learning-center/presentations/2007/interpreting-the-gi-effects-profile

● If you want to REALLY invest in learning to interpret this type of test, consider attending one ofMetametrix's provider training sessions in Atlanta, GA (www.metametrix.com, (800) 221-4640)

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All Disease Begins in the Gut 202

Part 2

This presentation is copyrighted by Purpose Inc. with all rights reserved, available for student reuse strictly subject to the terms outlined in the student program agreement.