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