HARNESSING THE POWER OF THE 5 R S FOR OPTIMAL GUT HEALTH

Transcription

1 HARNESSING THE POWER OF THE 5 R S FOR OPTIMAL GUT HEALTH Dana M. Elia, MS, RDN, LDN, FAND Owner, Fusion Integrative Health & Wellness, LLC Adjunct Faculty, Pennsylvania College of Health Sciences Lancaster, PA DIFM DPG Chair-Elect

2 Speaker Disclosures Dana M. Elia, MS, RDN, LDN, FAND has indicated no relevant affiliations or financial interests Speaker has not presented any promotional talks for, or consulted with, industry within the past 12 months

3 Objectives Review the factors contributing to poor GI health Identify patients at risk for increased intestinal permeability Describe patients may that benefit from a 5R program State the 5R process and the tools to aide both patient and clinician in the process

4 Learning Need Codes 3000 Nutrition Assessment & Diagnosis 5000 Medical Nutrition Therapy 5420 Complementary care, alternative therapies* *DIFM submitted to a CDR a proposed modification of this code to integrative and functional medicine

5 Functional Medicine asks how and why illness occurs and restores health by addressing the root causes of disease for each individual. Jones, D. S., & Quinn, S. (2017). Reversing the Chronic Disease Trend: Six Steps to Better Wellness. The Institute for Functional Medicine.

6 When in doubt start with the gut!

7 Widespread digestive issues in the US 35 visits to a doctor for every 100 people are for digestive concerns 8% of Americans have chronic digestive diseases 6% have acute digestive episodes 43% have intermittent digestive issues 70% of Americans report having digestive related symptoms or diseases Everhart JE, editor. The burden of digestive diseases in the United States. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: US Government Printing Office, 2008; NIH Publication No [pp. ].

8 Why address gut health first? Dysfunction of one s GI system can have a downward spiral effect on overall health. From a functional lens we recognize the interconnectedness between: Digestion/Absorption Intestinal Permeability Gastrointestinal Flora balance vs dysbiosis Immune Regulation & Inflammation Enteric Nervous System Gut brain axis

9 Beyond digestion wonders of the gut! Body s 2 nd Brain 1 produces 3/4 of the neurotrans mitters 2 contains 2/3 + of the immune tissue 3 contains 10 times more cells than the rest of the body combined 4 houses a genome 100 times larger than the human genome 5 has a metabolic activity greater than the liver Immune System Ground Zero

10 Awareness of the digestive process. Is there a breakdown or barrier in the cycle? Food is information! Eat/Chew Digest Absorption Assimilation Excretion

11 Gut Microbiota/Dysbiosis Healthy gut ecology, biofilms, prebiotics, and probiotics Involved in: - digestion of lactose and proteins - balance intestinal ph - benefits to bowel habits - reduce intestinal inflammation - EFA s and SCFA production - conversion of flavonoids - protection against pathogens - activate mucosal-associated lymphoid tissue (MALT) - protect and modulate autoimmune diseases El Hage, R., Hernandez-Sanabria, E., & Van de Wiele, T. (2017). Emerging Trends in "Smart Probiotics": Functional Consideration for the Development of Novel Health and Industrial Applications. Frontiers in microbiology, 8, doi: /fmicb Hemarajata, P., & Versalovic, J. (2013). Effects of probiotics on gut microbiota: mechanisms of intestinal immunomodulation and neuromodulation. Therapeutic advances in gastroenterology, 6(1), Lipski, Elizabeth. Digestive Wellness: Strengthen the Immune System and Prevent Disease Through Healthy Digestion, Fourth Edition. McGraw-Hill Education. Kindle Edition.

12 The Unhealthy Gut DAMAGE TO GOOD BACTERIA INVASION OF BAD BACTERIA COMPROMISED IMMUNE SYSTEM POOR DIET ALCOHOL CHEMICALS STRESS INFECTION LACK OF NUTRIENTS FOR CELL REPAIR LOSS OF CELL INTEGRITY LEAKY GUT FOOD ALLERGY IMPAIRED DIGESTION AND ELIMINATION DISEASE

13 Alteration of commensals High antibiotic use, especially in children C-sections High animal protein and dairy diet Intestinal surgeries: ileocolic resection (ICR), bariatric Celiac disease Motility disorders: gastroparesis Inflammatory Bowel Disease (IBD) Post infectious IBS: gastroenteritis Small Intestinal Bacterial Overgrowth (SIBO)

14 Remove Replace Re-inoculate Repair Rebalance The Five R s

15 The 5 R s PROCESS TO HELP REDUCE INFLAMMATION AND HELP TO HEAL THE GUT TARGETED, INDIVIDUALIZED INTERVENTION PROCESS TO NORMALIZE CRITICAL GASTROINTESTINAL FUNCTIONS

16 Critical Thinking What does this individual need to have Removed? What does this individual need to have Replaced? What does this individual need in terms of support to achieve a healthy balance of microflora? What does the client need to Re-inoculate their gut? What does this individual need to support healing and Repair of their GI barrier function? What does this individual need to do to Rebalance their lifestyle?

17 Remove What factors are we asking the client to eliminate or remove: Foods to which an individual is sensitive, intolerant, or allergic Poor quality, processed foods Pathogenic microflora (bacteria, fungi, parasites) Toxins, chemicals, environmental stressors such as pollutants Chronic stress Personalized approaches may include: Elimination diet reduce intake of foods that can trigger systemic reactions in order to reduce inflammation, lower the allergenic load, and provide the gut with a dietary base to allow for restoration Botanical antimicrobials or bacteriostatic/bacteriocidal phytonutrients Referral to PCP for antibiotics/antifungal medications

18

19 Replace Providing replacement of or support for factors that may be inadequate or lacking. Personalized interventions may include: Digestive support Hydrochloric acid Pancreatic enzymes Bile salts Adequate fiber intake to support GI function transit and elimination

20 Assessment of need for digestive support: Critical Thinking - Replace Hypochlorhydria Pancreatic enzyme insufficiency

21 Replace Causes of maldigestion Insufficient HCL Insufficient intestinal brush border enzymes Decreased CCK stimulation of pancreas Insufficient pancreatic enzymes Insufficient bile acids

22 Replace Institute for Functional Medicine (2010). Textbook of Functional Medicine Kines, K., & Krupczak, T. (2016). Nutritional Interventions for Gastroesophageal Reflux, Irritable Bowel Syndrome, and Hypochlorhydria: A Case Report. Integrative Medicine (Encinitas, Calif.), 15(4), Lipski, E.(2011) Digestive Wellness, 4th ed. NY, NY: McGraw-Hill Mullin, G. (2011). Integrative Gastroenterology (Weil Integrative Medicine Library) Oxford University Press, USA. Kindle Edition. Rakel, D. (2018). Integrative medicine (4th ed.). Philadelphia, PA: Elsevier Saunders. Yago, M. A. R., Frymoyer, A. R., Smelick, G. S., Frassetto, L. A., Budha, N. R., Dresser, M. J., Benet, L. Z. (2013). Gastric Re-acidification with Betaine HCl in Healthy Volunteers with Rabeprazole-Induced Hypochlorhydria. Molecular Pharmaceutics, 10(11), Providing Support for Proper Gastric Acidity Betaine HCL tablets ( mg) taken with proteincontaining meals Umeboshi plums Digestive enzymes with acid ph range Swedish/digestive bitters Gentian root Vinegar (ACV) Lifestyle factors - reduce stress, increase exercise, sleep

23 Re-inoculate Supportive reintroduction of beneficial GI microflora (prebiotics, probiotics, synbiotics) to achieve a more desirable balance to the intestinal microbiome. Personalized interventions may include: Cultured and fermented foods Probiotics: Bifidobacteria strains Lactobacillus strains Saccharomyces boulardii Prebiotics: Inulin or fructooligosaccharides (FOS) Soluble fibers Synbiotics: Bifidobacteria and FOS Lactobacillus and inulin

24 Determining the need for probiotics? What if you have a stool test? Stool culture Microbiology Potentially Pathogenic Bacteria/Yeast: NORMAL Potentially Pathogenic Bacteria/Yeast: EXCESS Beneficial Bacteria: NORMAL Probiotics not needed. Encourage continued support of microbial balance. Consider prebiotics and probiotics. Antimicrobials* (botanical vs rx) Beneficial Bacteria: DEFICIENT Supportive supplementation with prebiotics and probiotics is needed Consider prebiotics and probiotics. Consider Antimicrobials*

25 Re-inoculate Jerusalem artichokes Onions Chicory Garlic Leeks Bananas Fruit Soybeans Burdock root Legumes Eggplant Honey Green Tea Yogurt, cottage cheese, kefir Sugar maple Chinese chives Peas Asparagus

26 Repair Nutritional support for healing and regeneration of the GI mucosa. Setting the stage for an anti-inflammatory foundation. Personalized interventions may include a combination of the following: Glutamine, arginine, vitamin A, vitamin D, vitamin C, zinc, pantothenic acid, vitamin E, carotenoids, quercetin Mucosal support phosphatidylcholine, slippery elm, DGL licorice, marshmallow root GALT function - lactoferrin, lactoperoxidase, whey immunoglobulins, colostrum Phytonutrient anti-inflammatories - curcumin, EPA, and DHA Institute for Functional Medicine (2010). Textbook of Functional Medicine Lipski, E.(2011) Digestive Wellness, 4th ed. NY, NY: McGraw-Hill Gaby, A. (2017). Nutritional Medicine, 2 nd ed. Concord, NH: Fritz Perlberg Publishing Mullin, G. (2011). Integrative Gastroenterology (Weil Integrative Medicine Library) Oxford University Press, USA. Kindle Edition. Rakel, D. (2018). Integrative medicine (4th ed.). Philadelphia, PA: Elsevier Saunders.

27 Personalized lifestyle interventions may include: Scheduling and relaxation Mindful eating and better choices Rebalance Heart rate variability/ biofeedback Yoga, meditation, prayer, breathing, or other centering practices Psychotherapy

28 Foundational Gut Healthy Plan Institute for Functional Medicine (2010). Textbook of Functional Medicine Elimination Diet Probiotics Vitamin D Lipski, E.(2011) Digestive Wellness, 4th ed. NY, NY: McGraw-Hill Gaby, A. (2017). Nutritional Medicine, 2 nd ed. Concord, NH: Fritz Perlberg Publishing Mullin, G. (2011). Integrative Gastroenterology (Weil Integrative Medicine Library) Oxford University Press, USA. Kindle Edition. Rakel, D. (2018). Integrative medicine (4th ed.). Philadelphia, PA: Elsevier Saunders. Omega-3 Fatty Acids L-Glutamine

29 The 5R Framework for Gut Restoration A properly functioning digestive system is critical to good health. In fact, problems with the gastrointestinal (GI) tract can cause more than just stomach aches, gas and bloating or diarrhea. GI issues may underlie chronic health problems that seem unrelated to digestive health, including autoimmune diseases such as rheumatoid arthritis and type 1 diabetes, skin problems such as eczema and acne rosacea, and heart disease (just to name a few). So in the bigger picture, how can we deal with all that can go wrong down there? In Functional Medicine we use a program that goes by the simple acronym of the 5Rs : remove, replace, reinoculate, repair, and rebalance. When applied to various chronic health issues, the 5R program can lead to dramatic improvement in symptoms, and sometimes even complete resolution. The elements of the 5R program are described briefly below. 1. Remove Remove stressors: get rid of things that negatively affect the environment of the GI tract including allergic foods, parasites and potential problematic bacteria or yeast. This might involve using an allergy elimination diet to find out what foods are causing GI symptoms or it may involve taking medications or herbs to eradicate a particular bug 2. Replace Replace digestive secretions: add back things like digestive enzymes, hydrochloric acid, and bile acids that are required for proper digestion and that may be compromised by diet, medications, diseases, aging, or other factors. 3. Reinoculate Help beneficial bacteria flourish by ingesting probiotic foods or supplements that contain the good GI bacteria such as bifidobacteria and lactobacillus species, and by consuming the high soluble fiber foods that good bugs like to eat, called prebiotics. Probiotics are beneficial microorganisms found in the gut that are also called friendly bacteria. Use of antibiotics kills both good and bad bacteria. Probiotics in the form of supplements or food are often needed to help reestablish a balanced gut flora. Fermented foods, such as yogurt, miso, and tempeh are food sources of probiotics. Prebiotics are food ingredients that selectively stimulate the growth of beneficial microorganisms already in the colon. In other words, prebiotics feed probiotics. Prebiotics are available in many foods that contain a fiber called inulin, including artichokes, garlic, leeks, onion, chicory, tofu, and other soy products. Grains such as barley, flax, oats, and wheat are also good sources of prebiotics. Another good prebiotic source is a supplement called fructo-oligosaccharide or FOS. The 5R Framework A useful tool to help develop targeted interventions to assist clients with normalizing gut health 4. Repair Help the lining of the GI tract repair itself by supplying key nutrients that can often be in short supply in a compromised gut, such as zinc, antioxidants (e.g. vitamins A, C, and E), fish oil, and the amino acid glutamine. 5. Rebalance It is important to pay attention to lifestyle choices. Sleep, exercise, and stress can all affect the GI tract. Balancing those activities is important to an optimal digestive tract. Version The Institute for Functional Medicine

30 Thank-you! Speaker Contact info: Dana Elia, MS, RDN, LDN, FAND Fusion Integrative Health & Wellness, LLC 270 Granite Run Dr. Lancaster, PA

31 References: El Hage, R., Hernandez-Sanabria, E., & Van de Wiele, T. (2017). Emerging Trends in "Smart Probiotics": Functional Consideration for the Development of Novel Health and Industrial Applications. Frontiers in microbiology, 8, doi: /fmicb Everhart JE,. (2008). The burden of digestive diseases in the United States. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: US Government Printing Office, NIH Publication No Gaby, A. (2017). Nutritional Medicine, 2 nd ed. Concord, NH: Fritz Perlberg Publishing Hemarajata, P., & Versalovic, J. (2013). Effects of probiotics on gut microbiota: mechanisms of intestinal immunomodulation and neuromodulation. Therapeutic advances in gastroenterology, 6(1), Ianiro, G., Pecere, S., Giorgio, V., Gasbarrini, A., & Cammarota, G. (2016). Digestive Enzyme Supplementation in Gastrointestinal Diseases. Current Drug Metabolism, 17(2), doi: / Institute for Functional Medicine (2010). Textbook of Functional Medicine Kines, K., & Krupczak, T. (2016). Nutritional Interventions for Gastroesophageal Reflux, Irritable Bowel Syndrome, and Hypochlorhydria: A Case Report. Integrative Medicine (Encinitas, Calif.), 15(4), Lipski, E.(2011) Digestive Wellness, 4th ed. NY, NY: McGraw-Hill Mullin, G. (2011). Integrative Gastroenterology (Weil Integrative Medicine Library) Oxford University Press, USA. Kindle Edition. Rakel, D. (2018). Integrative medicine (4th ed.). Philadelphia, PA: Elsevier Saunders. Yago, M. A. R., Frymoyer, A. R., Smelick, G. S., Frassetto, L. A., Budha, N. R., Dresser, M. J., Benet, L. Z. (2013). Gastric Re-acidification with Betaine HCl in Healthy Volunteers with Rabeprazole-Induced Hypochlorhydria. Molecular Pharmaceutics, 10(11),