Heal Your Gut. Thrive Center for Personalized Healthcare and Wellness Dr. Nancy Palermo

Transcription

1 Heal Your Gut Thrive Center for Personalized Healthcare and Wellness Dr. Nancy Palermo

2 Healthcare 2018 Chronic disease is the century s greatest challenge and physicians and patients must adapt to meet it. Mark Hyman MD

3 Healthcare million individuals have at least one chronic disease and 42% of these individuals have 2 or more chronic diseases Chronic disease is responsible for 65% of deaths each year. (1.7 million deaths per year)

4 Chronic disease is disabling and reduces an individuals quality of life. Costs account for 18.8 % GDP (3.2 trillion dollars) (Every 30 secs an individual loses a limb to diabetes) Chronic Disease % of prescriptions Chronic disease is disabling our healthcare systems and is driving up costs 81% of hospital admissions 85% of all health care costs

5 Chronic Disease 2018 A Pill For Every Ill. 70% of Americans take at least one prescription drug and 20% of Americans take 5 or more ( Mayo Clinic) Prescription Drug Expenditures were 121 billion dollars in 2000, 360 billion in 2018 and are expected to reach 610 billion dollars by 2021

6 Healthcare 2018 Over 100,000 deaths per year in the US are caused by prescription drugs and that does not take in account the opioid epidemic

7 Times of change and disturbance call us to examine and clarify and commit to renew individual and community practices Thomas Jahnike Healthcare in 2018

8

9

10 Change is needed. We are living during a time of grand convergence in medicine different factors are all pointing us to a new paradigm for creating health

11

12 Functional Medicine An approach to health that considers genetic, environmental and lifestyle factors that influence health and chronic disease Treats more that just the symptoms The body is treated as a whole system rather than simply a collection of organs Empowers the patient to take an active role in their own health through education and support.

13 Functional Medicine Functional Medicine seeks to improve the quality of life for everyone

14

15

16 Avicenna ( AD ) The knowledge of anything, since all things have causes, is not acquired or complete unless it is known by causes. Therefore in medicine we ought to know the causes of sickness and health

17

18

19

20

21 Hippocrates

22 Why Focus on the Gut? The most effective clinical outcomes across all disease spectrums can result from the normalization of gut function.

23

24

25

26

27 60-70 million affected with GI issues 483 million office visits for GI related issues Gut Health in America 21.7 million hospitalizations for GI related issues 245,921 deaths related to GI issues 20.4 million surgical procedures related to GI issues Cost to treat GI issues is billion dollars (44 billion dollars in indirect costs)

28 Organ that produces ¾ of all neurotransmitters in the body Organ that contains 2/3rds of the immune system Why Focus on the Gut? Organ that contains as many cells as the rest of the body combined Organ that houses a genome times larger than the human genome Organ with metabolic activity greater than the liver 70% of Americans have digestive related symptoms

29 Digestion and Absorption of Nutrients from Food Key Functions or Roles of the Gut Immune Sensing ( houses 70% of the immune system and responsible for detecting friend from foe) Eliminate Waste and Begin Process of Detoxification

30 Normal Digestion - Mouth Mastication Breaks up food into smaller portions and allows mixture with saliva Saliva moistens food and releases Amylases that digest polysaccharides

31 Normal Digestion - Stomach Mechanical Breakdown of Food Enzyme Hydrolysis of Carbohydrates, proteins, lipids and nucleic acids Production of Intrinsic Factor and Hydrochloric Acid and Hormones that Dictate and communicate with other systems in the body

32 Functions of the Small Intestine Partially digested food from the stomach is mixed with bile and pancreatic enzymes to further breakdown and absorb nutrients. Primary site of nutrient absorption

33 Absorbs water and vitamins Functions of Large Intestine Converts digested food to feces Houses billions of gut bacteria providing vital roles for vitamin production, neurotransmitter production as well as clear effects on physiologic, immunologic and metabolic processes in human health

34 Immunological Defense Functions of Large Intestine Largest Lymph Organ in the Body ( 70% of the immune system and immunoglobulin producing cells are located in the GI tract) Populated by the highest number of immune cells and host protecting agents

35

36

37 The Microbiome Why all the Hype? In 2007 there were 396 research papers on the microbiome, in 2015 there were 5512 published on the same subject. Google Microbiome today and you will find more than 19,000 ongoing or recent studies on the microbiome

38

39 Microbiome Basics Makes up 1-3 % of body mass Genes of microbiome outnumber our genes 100 to 1 Primarily in the gut but also on the skin and mucus membranes of the respiratory tract and genitourinary tract Encompasses over 10,000 species and over a trillion organisms

40 The Gut Microbiome Clear effects on physiologic, immunologic and metabolic processes in human health Aberrations in the gut microbiome and intestinal homeostais have the capacity for multisystem effects Changes in microbial composition are implicated in the increasing propensity for a broad range of inflammatory diseases including allergic disease, asthma inflammatory bowel disease and obesity

41 Roles of the Gut Microbiome: Harvest of Nutrients, Vitamins and Energy Bacteria provide enzymes to allow digestion and and absorption of nutrients from food through specific enzyme activities Production of Vitamin K2 (think heart and bone health) and some of the B vitamins ( think energy and about everything else) Genus of Bacteriodes synthesizes CLA [conjugated linolenic acid] which has anti-diabetic, anti-athleroscrotic, antiobesogen and antiinflammatory properties

42 Roles of the Gut Microbiome: Immunity 1 Repair of damaged gut epithelium and renewal through presence of the mucosal barrier 2 Maturation and activation of innate and adaptive immune systems through development of the gut associated lymphoid tissue (GALT) 3 Control of pathogenic bacteria through competition of nutrients

43 Balanced versus Unbalanced Microbiome

44

45 Symbiotic Role of Gut Microflora Ferment non-digestible dietary residues releasing short chain fatty acids ( SCFAs) and Vitamin K ( production of these SCFAs control epithelial proliferation and differentiation protecting against the development of neoplasia) Have a barrier effect to provide resistance to colonization by potentially pathogenic bacteria

46 Roles of the Gut Microbiome: Production of Short Chain Fatty Acids and Appetite Control Breakdown ingested carbohydrates called polusaccharides, into smaller bits called short chain fatty acids (SCFA) When there are higher SCFAs fat cells release leptin which sends a signal to the brain that we are full stop eating.

47

48 Production of many neuroactive compounds occur in the gut 75% of body s serotonin is produced in the gut by gut bacteria Roles of the Gut Microbiome: Behavior Lactobacillus rhannous role in increasing GABA production and decreasing cortisol production Bacteroides infantis increases production of tryptophan Elevations of potential pathogen Citrobactor rodentium is associated with an increase in anxiety and a decrease in memory

49

50

51

52

53

54

55 Remove Replace The Five R s of Gut Healing Reinoculate Repair Restore and Rebalance

56 Heal Your Gut Improve Diet ( nutrient dense foods; Essential Fatty Acids; Fiber; Phytonutrients) Remove Toxins ( infections/toxic foods/toxins) Support Digestion ( Enzymes/ HCL) Support Normal Flora- ( Pre- and Probiotics) Support Repair and Regeneration ( DGL/Glutamine/Aloe) Immune Modulators ( nutrients/ antioxidants/herbs)

57 Pathogens Allergenic foods Remove Toxins Inflammatory foods ( processed; sugar; alcohol)

58 When Things Go Wrong..(Triggers to Gut Dysregulation) Nutrient deficiencies ( Standard American Diet) Medications ( NSAIDs; Antibiotics; AcidBlocking Drugs) Infectious Agents ( viruses; pathogenic bacteria; parasites) Ethanol Free Radical Production ( toxins/ preservatives/artificial additives) Food Allergies and Intolerances ( ex.gluten/dairy) Diminished HCL, enzyme and bile secretion Stress Chronic Inflammation ( from chronic diseases or poor diet)

59

60 The Standard American Diet Processed Foods Foods laden with sugar, salt, hydrogenated fats and artificial, manmade ingredients Artificial Food Coloring Exhibits anti-bacterial and anti-fungal properties which acts to reduce commensal bacterial counts

61 The Standard American Diet Sugar Changes the ph of the gut Feeds the bad bactria which then in turn increases sugar cravings Inflammatory through the actions of insulin Allows overgrowth of Yeast, Candida albicans Candida albicans pulls minerals from our bones

62 SAD Diet High Fructose Corn Syrup Feeds potential pathogens Causes an increase in fermentation, gas & diarrhea Causes increase in gut permeability which leads to inflammation and leaky gut

63

64

65

66

67 Alcohol Has been shown to thin the mucus membrane of the gut and increase permeability leading to bacteria translocation

68 Stimulates stomach cells to produce more HCL adding to stomach upset Relaxes esophageal-stomach schincter increasing reflux Blocks the actions of GABA in the gut leading to an oversactive bowel. Decreases absorption of Magnesium, Calcum, Zinc, and Iron Coffee

69

70 A Clean Environment..Too Clean? Use associated with an increase in antibiotic resistant strains Research shows use in children associated with increase in risk of allergies through affect on immune system in gut Gets into water systems and sewers and affect plant life

71 Live Clean, Eat Dirty!

72 Chlorinated Water Water is chlorinated to kill potential pathogens which is good The same effect kills commensal or good bacteria in the gut

73 Drugs

74 Drugs That Mess With Your Gut Proton Pump Inhibitors ( Prilosec; Zantac; Pepcid ) Antibiotics Non-steroidals ( Advil; Motrin; Anaprox) Birth Control Pills Steroids ( Prednisone ) Acne Medications

75 Antibiotics Reduction in numbers and diversity of commensal bacteria

76 PPIs and Health

77

78 GMO Glyphosate (Roundup herbicide) has been shown to disrupt the ability of beneficial bacteria to produce crucial amino acids needed for neurotransmitter production Glyphosate is used in over 750 products and has a role in genetically modified crops like soy, corn and canola. Also negatively affects Vitamin D activation in the liver and is being linked to the epidemic levels of Vitamin D deficiency

79 GMOs, Pesticides and Gut Health

80 A Word About Gluten A high glycemic food that increases blood sugar and insulin reaction Contains gliadin-derived peptides that can affect the brain in an addictive manner Gliadin has been shown to increase the permeability of the gut even in people without celiac Phylates in wheat may block your absorption of important minerals like iron, magnesium and zinc.

81

82

83

84

85

86 Stress and Your Gut Stress is associated with an increase in Cortisol levels which in turn increase inflammatory cytokines which increase dysbiosis and leaky gut

87 Looking for the causes Comprehensive Stool Testing SIBO Testing

88 Looking for the Causes Allergy Testing Food

89 HCL Replace Digestive Enzymes Herbal and Botanical supplements

90 Lactobacilli Bifidobactor Reinoculate Saccharomyces bolardii Prebiotics

91

92 Probiotics

93 Probiotic Foods Kefir billion High in Vitamin C and digestive enzymes Good source of lactic acid bacteria like lactobacillus Natto Fermented soybenas Contains bacillus subtilis which improves immune system, and increase production of B12 and K2 Over 31 gm of protein too

94 Probiotic Foods Yogurt Cannot be pasturized or homogenized, best if raw Grass-fed goat and sheep best or A2 cows Always organic No sugar added!! Sauerkraut High in Vitamin C and digestive enzymes Good source of lactic acid, with bacteria like bactobacillus Kimchi, Japanese cousin to sauerkraut

95 Choosing Probiotics For healing or digestive issues would take 50 billion and up to 200 billion Cannot be fermented or heat treated ( think dead bacteria?) No sugar added if symbiotic added should only be plant start or fiber

96 Choosing Probiotics Potency guaranteed until time of expiration Free of chemicals and all allergenic products like gluten, corn and soy Contain multiple strains including Bifidobacterium, Lactobacillus ad Bacillus. Protected from light, heat and moisture. REFRIGERATION BEST

97 Choosing Probiotics Multi-species which includes the following strains Bifidobacterium bifidum, longum, breve, infantis Lactobacillus casei, acidophilus, bulgaris, brevis and rhamnosis Bacillus subtilis and coaulans Saccharomyces bollardii in certain circumstances

98 Glutamine and Antioxidants Repair Essential Fatty Acids Fiber

99 Glutamine Vital nutrient to rebuild and repair intestinal mucosa Improves IBS and leaky gut by balancing mucus production Curbs cravings for sugar and alcohol

100 Essential Fatty Acids

101 Prebiotics Foods - Fiber

102 Rebalance Sleep Exercise Stress reduction Lifestyle Choices

103 Medicine Can Be Just as Heroic When Preventing a Problem

104