Whole Health in Your Practice - Applying CIH March Whole Health in Your Practice 14. APPLYING CIH. Lucky Sarah VETERANS HEALTH ADMINISTRATION
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1 Whole Health in Your Practice 14. APPLYING CIH Lucky Sarah 1
2 Not-so-lucky Joe Joe - GI 31 yo Diarrhea predominant IBS after being treated for a GI infection during a tour in Iraq Symptoms: Bloating and gas Cramping Up to 6 watery, non-bloody stools a day Not sure what he wants to do with his life since returning to the states. After taking all those antibiotics, my bowels have been messed up! 2
3 Key Questions to Ask. Was there a disruption to the normal GI ecosystem? Infection Trauma (physical, emotional) Antibiotics/Chemo Chronic Stress Surgery The Pathophysiology 3
4 Sarah Positive Balance Peace: Balance of sympathetic & Para-sympathetic tone Joe Negative Balance Stress: Sympathetic tone Proper Acidity (ph 1-3) Healthy Mucous Layer Low bacterial growth Intact gut-immune barrier or Acidity Poor Mucous Layer High bacterial growth Intestinal Permeability bacterial growth & balanced flora Regular evacuation Imbalanced bacterial growth (dysbiosis) Irregular evacuation Video: How a Bean Becomes a Fart From: Men s Health 4
5 The Enterocyte: Regenerate every 3-5 days! Brain-Gut Stress (Mast Cells) Histamine Serotonin Exorphins Intestinal Permeability Epithelial Damage Antigen Exposure Inflammatory Cell Recruitment ROS Release H+ Calprotectin Glutathione in Liver. 5
6 The Acid Acid Activates Pepsin Protein Pepsinogen PH= Active Pepsin Protease 5 days of PPI= PH>4.0 PH=>4.5 Inactive Pepsin Protease Amino Acids Immune Response Intact Protein 6
7 Risks of Chronic Acid Suppression Infection: C.Diff/H.Pylori Small bowel bacterial overgrowth Community acquired pneumonia Eosinophilic esophagitis Absorption: Fe (anemia) B12 (fatigue, neuropathy) Mg (arrhythmia) Calcium (hip fracture) Increased risk of myocardial infarction Increased risk of chronic kidney disease,? Memory Loss Rebound Dyspepsia W/ D/C of PPI Niklasson A, et al. Dyspeptic symptom development after discontinuation of a proton pump inhibitor: A double-blind placebo-controlled trial. Am J Gastroenterol
8 The Microbiome First Exposure Birth (C/S vs Vagina) Feeding (Bottle vs Breast) Group B Strep Prophylaxis? (Antibiotic Exposure) 8
9 Saari, A., et al., Antibiotic exposure in infancy and risk of being overweight in the first 24 months of life. Pediatrics, (4): p You can t make this crap up or maybe you can! RePOOPulate Petrof E.O., et al. (2013). Stool substitute transplant therapy for the eradication of Clostridium difficile infection: RePOOPulating the gut, Microbiome, 1 (1) 3. 9
10 Ridaura, V.K., et al., Gut microbiota from twins discordant for obesity modulate metabolism in mice. Science, (6150) L. Rhamnosus & Mouse Anxiety Prolonged swimming in water Less stress and depression GABA receptor stimulation No Δ when vagus nerve cut Bravo JA, et al. Ingestion of Lactobaccillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. PNAS. July,
11 22 Food Intolerance 11
12 Food Intolerance: The Usual Suspects **Most prevalent in infants and children Dairy (Cow s Milk Protein)** Wheat (Gluten)** Peanut** Corn (including corn syrup) Eggs** Citrus Soy** Beef Refined sugar Food additives Tartrazine (Yellow dye #5) Aspartame Domesticated Wheat: Hybridized > 40 chromosomes (vs 14) Short (dwarf) More gluten with more subtypes 12
13 The 3 Faces of Wheat 1. Celiac: Autoimmune 2. Protein Sensitivity, NCGS 3. Fructans: Sugar, FODMaPs Is Wheat Sensitivity Real? Carroccio, A., et al., Non-celiac wheat sensitivity diagnosed by double-blind placebocontrolled challenge: exploring a new clinical entity. Am J Gastroenterol, (12): p
14 FODMaP Diet (IBS) Fermentable-Oligosaccharides Wheat, Rye (onion, garlic, leeks) Disaccharides Milk products Monosaccharides Good symptom relief in 75%, No effect in 25%. Jl of Gastroenterology and Hepatology 25 (2010) Fructose (apples, pears), HFCS, Honey Polyols Sugar alcohols: sorbitol, xylitol, mannitol, maltitol Low FODMaP App 14
15 Gut Directed Hypnotherapy: 3 month results sustained up to 1 year! Lindfors, P., et al., Effects of gut-directed hypnotherapy on IBS in different clinical settings-results from two randomized, controlled trials. Am J Gastroenterol, (2): p VETERANS 30 HEALTH ADMINISTRATION Treatment (Joe) Referral to Social Services (vocation support) MBCT with Gut Directed Hypnotherapy More high fiber multi-colored whole foods, less fat and sugar. FODMaPs Probiotic x 4 weeks (Lacto, Bifido & Saccharomyces) w/ soluble fiber. 15
16 What Worked? Food elimination? Supplements? Having a plan? Increased sense of control? Relationship? All or One? Love is Contagious Lucky Joe Lucky Sarah 16
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