Dr Ameeta Gajjar BSc (Hons) MB BS (London)

Transcription

1 BSc (Hons) MB BS (London) MRCGP (UK) FRACGP FACNEM!1

2 PHYSICAL EMOTIONAL HEALTH MENTAL SPIRITUAL!2

3

4 Stress and Lifestyle medicine 21 st century health epidemic - World Health Organisation Lifestyle as medicine has the potential to prevent up to 80% of chronic disease; no other medicine can match that. In addition, it is potentially inexpensive and even cost-saving; free of all but good side effects; safe and appropriate for children and octogenarians alike. It is, quite simply, the best medicine we ve got. Dr David Katz, MD, MPH, FACPM, FACP, Former President, American College of Lifestyle Medicine, Founding Director, Yale-Griffin Prevention Research Center

5 Food Intolerances/Allergies Nutritional Deficiencies Psychological Gut dysbiosis Environmental!5

6 Autonomic Nervous System Sympathetic flight /fight Parasympathetic- rest and digest, repair and restore Stress sympathetic dominance implications Leaky gut, inflammation, gut microbiome changes, ANS Parasympathetic system reduced function hence gut often compromised when there is stress. E.g. digestive enzymes, stomach acid, motility. Mediated by Vagus nerve Body directs resources to where it is needed at the expense of other organs We are adapted well for acute stress but not for chronic stress over months and years. Results in what is commonly referred to as adrenal fatigue strictly speaking HPA axis dysfunction

7 GUT HEALTH Known in traditional medicine systems for thousands of years - not new concept. >5000 yrs ago- AMA in Ayurveda: sticky waste-product/toxin of digestion that builds up in the digestive tract due to weak digestion or when overloaded with the wrong foods. It can then build up and leave the digestive tract and circulate, affecting other parts of the body. All disease begins in the gut - Hippocrates ( BC) Research- Gut microbiome and links with chronic illness including diabetes, cancer, heart disease, autoimmune conditions, children s learning / behavioural disorders (Autism, ADHD), obesity, weight, neurological conditions (e.g. Dementia, Parkinsons)!7

8 The Gut 9m long tube from mouth to anus Largest interface between the outside world and internal environment. Approx m2 (2 tennis courts!) 80% of the immune system 2 nd brain: More neurons in Gut than SC 70% of neurotransmitters are found in gut. 90% serotonin made in gut.!8

9 Gut Microbiome 90 trillion bacteria (at least) and 10 trillion human cells- we are 90% bacteria and 10% human (mostly in gut) Bacterial genes- >1M genes. Humans- 23K genes Microbiome:1.5-2kg in weight (3% body mass) Microbial diversity is key to good health Fibre is key factor in healthy diet (SCFA) First 1000 days - Birth to 3 year period is critical Look after your gut and it will look after you!!9

10 Increased Intestinal Permeability ( Leaky Gut )!10

11 Leaky Gut, Leaky Brain!11

12 Conditions Associated With Leaky Gut Digestive issues- bloating, cramps, gas, diarrhoea, constipation, IBS Autoimmune conditions- Coeliac, Hashimoto s, Ulcerative Colitis, Crohn s, Type 1 diabetes, Lupus, Rheumatoid Arthritis Diabetes Heart disease Mental health- Depression/Anxiety, Bipolar, Schizophrenia Autism, ADHD, Learning and Behavioural disorders Cancer Fatigue Allergies and intolerances Eczema, Acne, Rosacea, Psoriasis Joint pains Chronic Fatigue Syndrome, Fibromyalgia PMS, Period problems, Infertility Candida, Parasites Asthma Weight/Obesity Endurance exercise!12

13 Food Wheat (gliadin) Sugar Alcohol Individual food intolerances Common- wheat/gluten, cow s milk, eggs FODMAPS and IBS Additives/preservatives Pesticides/herbicides (e.g Roundup- glyphosate) Infections Bacterial dysbiosis, parasites, yeast Endotoxins in gut/liver (LPS) SIBO/SIFO!13

14 Hormonal imbalance Imbalance in thyroid hormones Digestion (gastric acid, digestive enzymes) Natural decline with age Affects digestion of proteins especially Autoimmune disease e.g. Hashimoto s thyroiditis, Coeliac disease, Ulcerative colitis/crohns, Type 1 Diabetes, Rheumatoid arthritis, Lupus, Sjogrens syndrome, MS!14

15 Nutrients What Causes Leaky Gut? Lack of key nutrients- omega 3, vitamin A,D, zinc Toxins- (Chemicals/Heavy metals/drugs) Mercury (esp if low antioxidant status) Antibiotics, steroids, NSAIDS, antacids/ PPI, OCP!15

16 THYROID GLAND Origin: thyros - shield like Butterfly shaped Weighs less than an ounce Thermostat sensitive to what s going on in the system Functions: * Spark plug *Controls metabolism (BMRstimulates use of oxygen/glucose to produce ATP) *Cellular metabolism *Temperature regulation *Protein synthesis *Growth and development (esp foetal/infancy) *Lipid breakdown and excretion of cholesterol in bile *Neurotransmitter!16

17 Thyroid Hormone System!17

18 !18

19 Tiredness/Fatigue Difficulty losing weight/weight gain Depression Cognitive- Sluggish, slow thinking, confusion Constipation Lack of motivation Dry skin and hair, hair loss Cold hands/feet Cold intolerance Diminished sweating Low basal body temperature!19

20 Morning headaches Needing more sleep than usual Low heart rate Long recovery period after exercise or illness Poor immunity and recurrent infections Low libido Feeling of fullness in throat, sore throat, transient neck pain Menstrual problems, infertility, recurrent miscarriage!20

21 Goitre- neck lump Outer third of eyebrows thin Soft, weak pulse Slow reflexes slow to relax Periorbital puffiness, puffy face Macroglossia, scalloped tongue Voice hoarseness Slowed speech Slowed movements Decreased SBP and increased DBP!21

22 Primary- problem in thyroid gland Most common cause worldwide- iodine deficiency Hashimoto s thyroiditis Autoimmune Most common form in western world Many undiagnosed due to inadequate testing Iatrogenic Thyroidectomy!22

23 Secondary- problem in pituitary gland- therefore TSH not being produced. Low TSH, low thyroid hormones E.g stress!23

24 Tertiary problem with peripheral conversion Most common Commonly missed as blood tests are normal Problem with T4 to T3 conversion. Can occur with Hashimoto s!24

25 TSH Only test usually done but not sufficient to assess thyroid function Can be normal even if there are thyroid problems. Within range interpreted as normal in conventional medicine TSH has no correlation with clinical presentation except at the extremes - Dr David Derry Free T3, Free T4, Thyroid antibodies (TPO Ab s, TG Ab s +/- TSH receptor Ab s), RT3 Urine iodine Thyroid USS Stool test CDSA, microbiome.!25

26 Tips To Improve Gut And Thyroid Health Diet Personalised- e.g GFDF, Paleo, AIP, Vegan, SIBO. Reduce/eliminate wheat /dairy & other known food intolerances No processed/fried foods, No refined sugar/carbs, No artificial colourings/preservatives/additives Reduce/stop alcohol VARIETY of foods. Rainbow colours of vegetables and fruit. Adequate protein intake (1g/kg approx) Fibre- adequate intake of vegetables, fruit, nuts/seeds Natural probiotics eg miso, sauerkraut, keffir, tempeh, kombucha. Clean filtered water Use herbs etc in diet e.g. turmeric, ginger, oregano, pomegranate, rosemary, dandelion, tulsi.!26

27 Tips To Improve Gut And Thyroid Health Supplements Gut healing herbs- aloe vera, slippery elm, curcumin (turmeric), glutamine Gut healing nutrients- zinc, omega 3, vitamin A and D Digestive enzymes/acid Apple cider vinegar, lemon juice Betaine HCl and digestive enzymes Natural - papaya, pineapple Probiotics Strain specific- Lactobacillus, Bifidobacterium, SB, Soil/spore Adrenal/thyroid herbs and nutrients!27

28 Improving Gut And Thyroid Health Exercise/Movement not too little, not too much! Stress/ Emotions Balance stress hormones e.g Yoga, meditation, nature walks, earthing, psychology Sleep 10pm-2am. Restoration of hormones- balancing cortisol and DHEA, GH. Detox- glymphatic system. Sleep is restorative- 1/3 of our lives! Environmental Filtered water Organic produce- avoid dirty dozen Personal care products (e.g parabens, phthalates) Chemicals in home (e.g plastics, fire retardants) Reduce plastic use (e.g water bottles and storage, cookware, coffee cups) Reduce EMR!28

29 Gut-Thyroid Connection 20% of thyroid hormone made in the gut by bacteria Leaky gut toxins/food particles affect any part of the body-inc thyroid gland Autoimmunity- molecular mimicry of food particles/ infections and the thyroid gland Microbiome and inflammation!29

30 !30

31 W: FB- Dr Amy Gajjar- Integrative Medicine