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1 Functional Diagnostic Medicine Training Program Module 2 The Functional Diagnostic Medicine Approach in the Treatment of Gastrointestinal Dysfunction and Disease Dr. Wayne L. Sodano, D.C., D.A.B.C.I. & Dr. Ron Grisanti, D.C., D.A.B.C.O., M.S. The goal of the functional medicine approach to treatment is to identify dysfunctions and disease processes, and restore biochemical, physiological, and metabolic aberrations. Dysfunctions are aberrations of physiology, while disease is the expression that is the sign and symptom of the dysfunction. The foundation and basic tenets of treating the gastrointestinal system include the following: Identify Evaluate Restore Heal 1

2 FDM Training Program: Mod 2: The Functional Diagnostic Medicine Approach in the Type and Amounts of Bacteria in Regions of the Gut For a typical healthy individual, bacterial populations change greatly moving from stomach to stool. The genus or class of predominant organism is shown inside each box and the total number of microbes per gram of intestinal content is shown at the bottom of the box. Ref: Lord RS, Bralley JA, eds. Laboratory Evaluations for Integrative and Functional Medicine. Duluth, GA: Metametrix Institute; Healing the Intestinal Lining The goal in this phase of treatment is to restore the integrity of the intestinal lining which includes the goblet cells and the immune system. Biology.clc.uc.edu/ /Human Histology.html Reprinted with permission: Lord RS, Bralley JA, eds. Laboratory Evaluations for Integrative and Functional Medicine. Duluth, GA: Metametrix Institute;

3 FDM Training Program: Mod 2: The Functional Diagnostic Medicine Approach in the Reprinted with permission: Lord RS, Bralley JA, eds. Laboratory Evaluations for Integrative and Functional Medicine. Duluth, GA: Metametrix Institute; 2008 An Overview of Non-Prescription and Prescription Agents Always check indications and contraindications of all agents before use. PDR s for botanicals, drugs, and supplements should be referenced. A stool analysis can provide information about sensitive agents and resistant agents. Gastric Inflammation/Gastritis Gastric inflammation is strongly associated with hypochlorhydria because many of the causes of hypochlorhydria actually cause atrophy of the gastric lining. An untreated gastric inflammation can lead to frank gastritis which is strongly associated with burning of the stomach and potentially even vomiting blood

4 Common Causes of Gastritis Helicobacter pylori and other bacteria Non-steroidal anti-inflammatory drugs Alcohol use Stress Bile reflux disease Helicobacter pylori Infection H.pylori is the bacterium that causes peptic ulcer disease. It s mode of transmission is: Oral to oral Fecal to oral Family inter-infection Helicobacter pylori (H.Pylori) may break down the stomach s protective coating, causing changes in the stomach s lining leading to stomach inflammation

5 Testing for H.pylori Laboratory H.pylori serology Urea breath test (carbon 13) H.pylori fecal antigen test Biopsy Histology Culture Rapid urease test Treatment Options for H.pylori PPI (proton-pump inhibitor)clarithromycinand amoxicillin or metronidazolefor days or PPI orhistamine-2 receptor antagonist, bismuth subsalicylate, metronidazole and tetracycline for days Note: H.pylori stains are showing increasing resistance to clarithromycin Natural treatments for H.pylori Bismuth subcitrate Mastic gum (Pistacea lenticus) Goldenseal (berberine) Pyloricil: DGL licorice wafers: (Douglas Laboratories) Sano-Gastril: 5

6 Yeast Infection Candida are normal inhabitants of the gastrointestinal tract and are present in % of the human population with no harmful effects. However, in conditions of overgrowth, various Candida sp. are most commonly found as the causal agents of opportunistic fungal infections. The esophagus is the most common site of infection, followed by the stomach, then the small and large bowel. Normal Esophagus Esophageal Yeast Causes of Candida Overgrowth Antibiotic use (main cause) High intake of sugar, milk, other dairy products and foods containing a high concentration of yeast or mold Hypochlorhydria Food allergies Depressed immune system Altered bowel flora Treatment of Candida sp. Reduce intake of refined carbohydrates and sugars May need to use pharmaceutical or botanical anti-fungal agents refer to sensitivity testing on stool profile S.boulardiiaids in the growth of beneficial bacteria, crowds out yeast, and helps with immune support. Avoid fructooligosaccharide(fos) as it may feed the yeast. Note:Most organic fatty acids are fungicidal and have been used for centuries as antimicrobial agents. Undecylenic acid has been shown to be approximately six times more effective as an antifungal than caprylicacid, and is effective in maintaining a healthy balance of intestinal and vaginal flora. 6

7 Causes Opportunistic Bacterial Infections Low predominant bacteria Pathogen or parasite infection Poor diet Antibiotic use Lowered gut immunity Klebsiella Citrobactor Salmonella Yersinia Causes: Pathogenic Bacteria C. difficile Antibiotic use Nosocomial Advanced age Fecal-oral colonization Campylobacter Contaminated animal sources Hydrochloric acid insufficiency Secretary IgA deficiency EHEC Contaminated food Escherichia coli (EHEC) Campylobacter Clostridum difficile (c.difficile) Parasitic Infections Cryptosporidium parvum on intestinal wall Giardia lamblia 7

8 Low Good Bacteria Usually discovered on stool analysis Causes Antibiotics Diarrhea Imbalanced diet Hypochlorhydria Acid Indigestion/GERD Deep Stomach Ulcer Gastric or duodenal ulcers and gastritis may result over time from too little stomach acid. 8

9 Pancreatic Insufficiency Causes include Stress Nutritional deficiencies Poor diet Eating only cooked foods Exposure to radiation or toxins Hereditary weaknesses Drugs Infections Hyperpermeability/Dysbiosis IBS/IBD IBS is the most common gastrointestinal disease seen in clinical practice. The term IBD is used to describe two chronic relapsing and remitting diseases Ulcerative colitis Crohn s disease Normal colon Ulcerative Colitis 9

10 Formation of gallstones is the result of three factors: Supersaturation of bile with cholesterol A decrease in bile salts that act to dissolve the cholesterol vesicles Stasis of bile flow Cholelithiasis Next Module The Immune System 10