Keith R. Holden, M.D. Internal Medicine Functional Medicine European Biological Medicine

Transcription

1 Keith R. Holden, M.D. Internal Medicine Functional Medicine European Biological Medicine Special Interests: Frequency-Based Medicine Mind-Body Medicine Member of The Institute for Functional Medicine

2 Food, Your Gut, and Your Health Keith R. Holden, M.D.

3 Gut Inflammation & Systemic Disease Total surface area (SA) of GI tract > 200X SA skin GALT contains over 70% of body s lymphocytes Gut immune dysfunction produces excessive inflammation resulting in systemic disease

4 Gut Associated Lymphoid Tissue (GALT) IACA 2013

5 Gut Dysfunction & Autoimmune Disease Genetic predisposition for immune overreaction to triggers Trigger (food, microbes) Intestinal hyperpermeability - AKA Leaky gut TRIAD in Celiac Disease provides clues for autoimmunity

6 Celiac Disease (CD) Gluten/gliadin proteins in wheat, barley & rye trigger autoimmune destruction of the small intestine Affects one in 133 Americans causing malnutrition and the associated side effects of malnutrition Having CD increases risk for other autoimmune diseases

7 Celiac Disease Triad #1 Fasano A. Sci Am. August 2009;301(2):54-61

8 Celiac Disease Triad #2 Fasano A. Sci Am. August 2009;301(2):54-61

9 Celiac Disease Triad #3 Fasano A. Sci Am. August 2009;301(2):54-61

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11 Three Types of Reactions to Food Food Allergy Food Sensitivity Food Intolerance

12 Food Allergy Immediate reaction IgE mediated Histamine release

13 Food Sensitivity Delayed reaction (72 hrs) Non-IgE mediated ( IgG, IgM, IgA) Cytokine release (Mediators of inflammation)

14 Food Intolerance Non-immune mediated Reaction to food toxins and additives(botulinum toxin, MSG, aspartame, sulfites) Absence of digestive enzymes (Lactose and fructose intolerance)

15 Non-Celiac Gluten Sensitivity Emerging as a separate condition from Celiac Disease Both respond to a gluten free diet

16 Gluten and Irritable Bowel Syndrome Double-blind randomized placebo controlled trial with Irritable Bowel Syndrome patients (no Celiac Disease) 68% of patients given gluten reported IBS symptoms not adequately controlled versus 40% given placebo Biesiekierski JR, Newnham ED, Irving PM, et. al., Am J Gastroenterol. March 2011;106(3)508-14

17 Gluten & IBS Study Summary Provides for the first time high-quality evidence that gluten may trigger gut symptoms and fatigue in individuals who do not have celiac disease Stimulates additional research to confirm the effect, mechanisms, and prevalence of this condition Impacts the use of gluten restriction on the management of patients with Irritable Bowel Syndrome

18 Non-Celiac Wheat Sensitivity(WS) Chart review of all subjects with IBS-like presentation dx with WS using DBPC challenge from patients with WS had a higher frequency of: Anemia Weight loss Self-reported intolerance to wheat Atopy & food allergy in infancy Positive serum markers for gluten sensitivity Histology: Eosinophilic infiltration of duodenum/colon Carroccio A, Mansueto P, Iacono G, et. al, Am J Gastorenterol, Dec 2012;107(12):

19 There is no one test that diagnoses gluten sensitivity in all individuals!

20 Why is Gluten Sensitivity Increasing? Hybridized wheat has increased gluten content and gluten is a common food additive IACA 2013 Toxins and hormones in food supply Compromised digestive enzymes Increased intestinal inflammation/infection/dysbiosis

21 William Davis, M.D. - Cardiologist IACA 2013

22 Glycemic Index (GI) of Wheat Higher GI causes more rapid rise in blood sugar (BS) Whole wheat bread GI 72 Table sugar GI 59 Snicker s bar GI 41 Wheat contains amylopectin A (contributes to rapid BS rise)

23 Wheat (High Glycemic Index Food) Cause a rapid elevation in blood sugar Stimulates insulin release (fat storage hormone) Accumulation of abdominal fat (VAT), which acts as an active endocrine organ pumping out inflammatory mediators and hormones (estrogen) VAT is associated with insulin resistance (T2DM)

24 Hybridization of Wheat Wheat strains hybridized & cross-bread for resistance to drought and pathogens Resulted in changes to genetic code altering protein (gluten/gliadin) structures Altered proteins cause abnormal immune response Others have immune response to non-gluten components of wheat

25 Wheat Withdrawal 30% of people have withdrawal sxs with elimination Studies show adverse affect of wheat on schizophrenics Rat study showed gluten + stomach acid produced polypeptides (gluteomorphin) that cross BBB, which is blocked by naltrexone Wheat may be an appetite stimulant (cravings)

26 Wheat Negatively Impacts Lipids Wheat and other high GI carbs increase TG/VLDL Sustained elevation in TG can be packaged into VLDL particles, precursors of small LDL particles (higher CV risk) Sustained elevations in lipids results in fatty liver, a potential precursor to cirrhosis

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28 Remove (Stressors) Address stress including old emotional toxins Food sensitivities (Elimination Diet, ALCAT) Detoxify external and internal biological toxins *Pathogenic microbes (bacteria, yeast, parasites)

29 *Priority Testing CDSA/Parasitology CDSA Comprehensive Digestive Stool Analysis Assesses levels of beneficial and pathogenic microbes Assesses gut inflammatory markers, bile salts, HCL status, and pancreatic enzyme function Does not assess for small intestinal bacterial overgrowth

30 HCL acid Replace Digestive enzymes Bile salts Fiber

31 Repair Rest Vitamins (pantothenate, E, A, D, C) Activated B vitamins Support of GALT function (lactoferrin, whey, Ig) Antioxidants (catechins) & minerals (zinc) Anti-inflammatories (curcumin, EPA/DHA/GLA) Glutamine and aloe vera

32 Reinoculate Probiotics (mix of Lactobacillus & Bifidobacter sp.) Saccharomyces boulardii (C. difficile) Prebiotics (Arabinogalactan)

33 Rebalance Lifestyle changes Scheduling rest and relaxation; adequate sleep Mindful eating Balance ANS (belly-breathing, HeartMath app) Balance brain waves (Cranial Electrotherapy Stim.)

34 Detailed Orodental Assessment Plaque (biofilm), amalgams, crowns, bridges Malocclusion stresses the ANS Old root canals (possible occult infection) TMJ (NM Dentist, CST, Chiropractor) Tongue, gums, mucous membranes, tonsils

35 Summary Foods can trigger abnormal immune response IACA 2013 Leaky gut (intestinal hyperpermeability) overwhelms liver detoxification & contributes to excessive inflammation Dysfunction of gut immune system creates excessive inflammation resulting in systemic disease (autoimmunity) Address the whole person (body/mind/spirit) Always address stress in your patients (#1 killer)

36 Case Study 44 y.o. healthy male with sudden onset of severe IBS Abdominal bloating, diarrhea, weight loss Moderate reaction to gluten on ALCAT Stool testing: 1+ Yeast Colonoscopy: Aphthous ulcers sigmoid colon Med history: Replacement of 7 silver amalgams one month prior to the onset of symptoms

37 Final Advice Stay open to possibilities Question status quo 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)

38 Keith R. Holden, MD 822 A1A North Ste 310 Ponte Vedra Beach, FL Ph: (904)

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