9/11/08 - Weebly
2/10/09
Nutr2 - Exam 2
Nutrition and The Digestive System: Part 1
Introduction to GI Disorders
■ A web-like link of systemic disorders to the GI tract
■ “Symptoms of gastrointestinal tract disorder existed with no known structural, pathological, radiological, and laboratory findings comprised forty-one percent of the membership’s practice” according to a survey conducted by the American Gastro-enterological Association.
■ Traditional treatment of GI problems relies on drugs such as anti-inflammatory agents, antacids, enteric nervous system inhibiting agents.
■ These approaches do not seek to uncover the underlying causes or triggers.
■ Suppressing symptoms rather than improving functions of the GI tract often lead to further deterioration.
■ Close interrelationship the GI tract plays with every major system in the body
GI-Immune, Pain, Inflammation
■ Over 60% of human immune system is in the GI tract
■ 99% of the body’s neurotransmitters
■ Any adverse antigen that interacts with the gut-associated lymphoid tissue (GALT) will trigger an inflammatory response
■ Lead to production of inflammatory mediators causing pain, inflammation and vasoconstriction
■ GI dysfunction is commonly found in patients with any chronic pain.
■ Complex inflammatory response lead to free radicals, interrupting the electron transport chain ( uncoupling of oxidative phosphorylation, damage DNA and perpetuates a viscous cycle of oxidative stress and inflammation
The Enteric Nervous System
-The central autonomic nervous system (hypothalamus and brain stem) mediates its influence on the gastrointestinal
function via the intrinsic, enteric nervous system
Cutting, Sheaving (bundling), and Stooking (shocking) Grain
from ancient Egypt (7000 BC)--to medieval Europe (1568)--to 20th century United States
-Since the beginning, each kernel of grain ripened in shocks in the field producing nutrients essential to the life of the
plant AND the life of the people.
THRESHING
After the grain had ripened sufficiently in the shocks, it was threshed. Threshing removes the grain from the stalks, winnows and collects the grain, and stacks the straw. For millennia, farmers did this by hand, flailing and pounding the bundles of grain by hand; or with devices powered by horses or other animals. In the late 19th and pre-WWII 20th century, individual farmers usually did not own threshing machines but hired a crew or depended on a communal arrangement to do the job.
I-A Cutting, Bundling and Shocking Grain
The cradle consisted of a broad scyth with a light frame of four wood fingers attached to it. The advantage of the cradle was that by a turn to the left the operator could throw the grain into a swath, ready to be raked and bound into sheaves. This improvement was introduced in America about 1776 and was the common instrument of grain harvesting as late as 1840. For cradling grain, two acres was considered a hard day's work for each man.
Threshing: A steam engine was set up in or near the grain field and was belted up to the threshing machine. A team of workers called "bundle haulers" went out into the field and loaded shocks onto a horse-drawn wagon. The filled wagon was brought up to the spot where the threshing machine was set up. Men standing on top of the wagon pitched the grain bundles down into the feeder which conveyed the bundles to the threshing cylinder where most of the grain was separated from the stalks. The separated grain fell to the bottom of the threshing machine, while chaff and dust was removed by a fan as it descended. An elevator on the threshing machine then transported the loose grain into a grain wagon parked nearby or into individual bags, depending on the method preferred. After the straw went through the cylinder, it was continually battered as it progressed along, ensuring that all the grain was removed from the stalks. At the rear of the threshing machine, after the straw had passed over the straw walkers, it was deposited in a fan housing which propelled the straw through the blower and into the straw stack.
Sheaves (bundles), Shocks (stooks) and Stacks
■ Shocks stood in the field for several weeks before threshing. Grain seeds were exposed to rain and dew which soaked into the sheaves. This moisture, combined with heat from the sun, germinates the seed.
■ Germination neutralizes enzyme inhibitors and releases the enzymes.
■ Germination increases the enzyme activity as much as six times.
■ Use of the modern combine harvester results in a mature but dormant (resting) seed. The modern method for germinating seeds is soaking before cooking.
-Edward Howell MD: Enzymes for Health and Longevity
Like “Industrial Agriculture,” Processed Whole Foods is an Oxymoron
■ Last week, the federal government released its Dietary Guidelines for Americans 2005…. Most media reports focused on the guideline’s emphasis on weight loss…. Emphasizing weight loss conveniently puts the onus for dietary change on the individual and avoids talk of refining in the food industry’s multibillion-dollar marketing budget for unhealthy foods…. Americans have become accustomed to eating highly processed foods that come in a package – the antithesis of whole foods that come from nature. The very definition of food has been transformed by industry, yet the dietary guidelines don’t reflect that. If they did, it would be a major threat to a five-hundred-billion-dollar-a-year processed foods industry whose voice is heard loud and clear in Washington…. But “processed whole foods” is an oxymoron.
-Michele Simon, San Francisco Chronicle, January 19, 2005
Civilization vs Nutrition
■ Readjustment of our chemical apparatus to changed conditions takes thousands of generations.
■ A general change in dietary habits taking place in one or two hundred years partakes of the nature of sudden disaster.
■ By adopting a standardized diet of refined and devitalized foods, we have thrust upon our endocrine system an insufferable task of rapid adaptation.
-Melvin E. Page, D.D.S., Body Chemistry in Health and Disease, 1953,54, distributed by: price-
Gut Associated Lymphoid Tissue
■ Lymphoid tissue in the gut, the gut part of MALT , which is comprised of the following:
■ Tonsils .
■ Adenoids (Waldeyer's ring). The tonsils and adenoids are made of lymph tissue and help to fight off infection. Largest in childhood and gradually shrink throughout life.
■ Peyer's patches .
■ Lymphoid aggregates in the appendix and large intestine.
■ Lymphoid tissue accumulating with age in the stomach. (?)
■ Small lymphoid aggregates in the oesophagus.
■ Diffusely distributed lymphoid cells and plasma cells in the lamina propria of the gut.
Processed Foods
■ Lack of enzymes
■ Removal of nutrients
■ Addition of synthetic chemicals
■ Practically un-digestible
■ Stimulate immune reactions
■ Lead to inflammation
The Vicious cycle of GI dysfunctions and pain, Inflammation and oxidative Stress
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health/health-info/docs/1600/1678.asp
Functional Hypothyroidism and the GI Tract Dysbiosis
■ 20% of active T3 is dependent upon a healthy gut microflora
■ Imbalance gut flora can cause a decrease in T3
■ Gut dysbiosis put stress on the adrenal glands ( cortisol
■ Cortisol can shift T4 into a higher percentage of inactive rT3 rather than the active T3
■ There are functions served by rT3—a break on the thyroid.
Reverse T3
The thyroid gland is the body’s metabolic thermostat controlling body temperature, energy use, growth rate, and affecting the operation of all bodily processes and organs.
Thyroid hormone production is centrally regulated: Thyroxine (T4) from the thyroid gland is peripherally converted in the liver and kidney cells into T3 and reverse T3 (rT3). T3 is the active hormone and is five times as potent as T4, but rT3 is almost biologically inactive.
RT3 can also be included into the Total Thyroid Screen on request or carried out separately. RT3 is primarily produced from monodeiodiation of thyroxin in the peripheral tissue rather than by direct secretion by the thyroid gland. Physical, mental and environmental stresses can inhibit the deiodinating enzyme, causing less T4 to be converted to T3, thus decreasing the amount of active thyroid hormone available to the cells. More T4 is then shunted towards rT3 causing an elevation in rT3. Measuring rT3 levels is useful when ‘sick euthyroid’ conditions are suspected.
When a patient produces excessive levels of rT3 they will usually present with hypothyroid symptoms.
Factors that can elevate rT3 levels:
Selenium deficiency
Potassium and Zinc deficiency
High stress levels especially high cortisol
Chronic illness
Cadmium, mercury and lead toxicity
High simple carbohydrate intake
Low protein intake / poor protein digestion
Starvation diets, fasting
Compromised liver or kidney function
GI Dysfunction and Autoimmune Disorders
Antigen exposed to GALT (
( Inflammation
( Increase intestinal permeability; Absorb middle and large molecular particles; Leaky Gut
( Up-regulate immune system
( Auto-antibody
( Autoimmune Disease
GI Disorders and Adrenal Stress
■ HPA axis involvement when the GALT is activated
■ Adrenal alarm response
■ Decrease DHEA ( reduce other steroid hormone production
■ Potential shift of physiology away from anabolic state to a catabolic state
■ Sub-clinical GI sensitivities to food antigen are major cause of adrenal stress and often undetected, unsuspected
■ Elevated cortisol suppress GI mucosal cells regeneration, decrease sIgA ( increases dysbiosis
GI Dysfunction and Adrenal Stress
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2/11/09
GI Dysfunction and Estrogen Dominance
■ Dysbiosis increase Beta Glucoronidase activity
■ Uncoupling the conjugated estrogen
■ Reactivate estrogen and increase total estrogen load and liver stress
■ Ratio of 2-OH and 16-OH estrogen imbalance toward increase risks of reproductive organs cancers
■ Friendly flora can further metabolize estrogen, prevents re-absorption into body
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GI Dysfunction and B-12 Deficiency
■ Megaloblastic anemia
■ B12 absorption is dependent on adequate HCl in the stomach, pancreatic enzymes and healthy brush border.
■ Increase serum homocysteine , an inflammatory marker
■ Emotional and psychological signs and symptoms
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GI Dysfunction on Moods and Depression
■ Decreases neurotransmitters synthesis and glucose absorption
■ Adrenal stress, cortiscol(insulin resistance
■ The enteric system produces 99% of the body’s serotonin (5HT)
■ Abnormal glucose absorption may cause glycemic dysregulation and impact on mood, behavior and emotion controls
GI Dysfunction and Weight Control
■ GI inflammation can disrupt intercellular communication and make weight loss very difficult
■ Gut inflammation cytokines can prevent lipolysis and increase lypogenesis
Gut and Weight
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Leaky Gut and Food Sensitivities
■ Healthy GI tract has tight junctions between enterocytes to prevent absorption of large food molecules.
■ During chronic inflammation or stress, tight junctions may be breached allowing large food molecule to enter bloodstream
■ Triggering histamine, leukotrienes, postanoids and PGs leading to food allergies.
Healthy Gut Leaky Gut
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GI Dysfunction and CVD
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GI Dysfunction and Neurodegenerative Disorders
Antigen exposure to GALT (
( Global alarm reaction
( Glial cells of brain release inflammation cytokines and nitric oxide
( Neuronal apoptosis
( Neurodegenerative diseases
GI Dysfunction and Chronic Fatigue
[pic]
When Do You Need to Change Diet?
■ Stiff, sore joints
■ Headache
■ Heartburn
■ Gas pain – bloating
■ Constipation – diarrhea
■ Anxiety – irritability
■ Restlessness – insomnia
■ Depression
■ Dr. Howard Loomis
GI Dysfunction and Liver Detox
■ Any form of GI imbalance will impair hepatic detoxification
■ Dysbiosis, leaky gut, antigen overload, inflammation reaction (increase demands on the liver
■ Pathogenic intestinal bacteria release lipopolysaccharides which goes to the liver and down-regulate the Cytochrome P450 enzymes
■ Beta glucoronidase up-regulation ( deconjugation of hormones and chemicals
■ Increase total liver workload
2/13/09
GI Laboratory Tests
■ Blood test: increase liver enzymes, antibodies
■ Urine: Increase indican level
■ Genova Diagnostic Labs: CDSA
■
■ Diagnos-Techs, Inc: CDSA
■
Reference
■ The information in this presentation is based on the “Functional Endocrinology” seminar by Datis Kharrazian, DC.
■ Dr. K had done extensive literature research on this subject.
■ For more information on Dr. K’s seminars on functional endocrinology, contact Apex Energetics —
■
Nutrition and the Digestive Tract—Part 2
Gut Facts
■ The GI tract is considered another brain, it works in conjunction with the cerebral cortex to help maintain homeostasis
■ About 60% of the total force of the immune system is in the gut. That makes the gut our most important immune organ
■ Before the brain was developed, the gut was the original brain in invertebrate animals.
■ The Second Brain, Michael Gershon
■ 95 % of the total serotonin production in the body is from the GI tract.
■ SSRI reduces serotonin to the GI tract and can cause nausea, vomiting and constipation.
■ One half of all our neurons of the peripheral nervous system are located in our digestive tract.
■ The state of the GI tract has a profound impact on our health. From the healthy gut, we enjoy health, neurologically, psychologically, as well as immunologically.
■ The GI tract has as many neural connections as the spinal cord.
■ Has more neurons than the rest of the peripheral nervous system
■ Forms the Enteric Nervous System
■ Connected to the brain via the vagus nerve
■ Can function independently—brain dead patients can continue to digest and absorb intubated feeding indefinitely
■ The gut produces all of the neurotransmitters and hormones that the brain does plus more.
■ The GI tract is highly susceptible to stress of any kind—emotional, physical and toxins
■ There are more than 10000 different kinds of microorganisms in the gut. Half of fecal weight is bacteria.
■ Probiotic or normal flora in the gut contributes numerous health benefits
Bacteria Citizens in Our Gut
|Common Human Intestinal Bacteria |Approximate Concentrations |
|Bacteriodes |~1010 / gram intestinal contents |
|Bifidobacteria |~109 / gram intestinal contents |
|Eubacteria |~109 / gram intestinal contents |
|Streptococci |~109 / gram intestinal contents |
|Lactobacilli |~108 / gram intestinal contents |
Function of Friendly Gut Flora
■ Produce vitamins such as folic acid, K, B12
■ Nourish the lining of colon by feeding on dietary fiber and produce butyric acid an essential fuel for the gut cells, reduce risk of colon cancer
■ Limit the growth of pathological microbes
■ Break down toxins
■ Assist in digestive process
GI Blues
■ Two of the top five most widely prescribed prescription drugs in this country are for digestive disorders.
■ Colorectal cancer is the second leading cause of cancer deaths.
■ More than 60 million Americans experience heartburn at least once a month, and about 25 million are daily sufferers
■ As many as 37 million episodes of diarrhea occur annually among America’s 16.5 million children under five, leads to three million physician visits each year and 163,000 hospital visits; accounts for 13 percent of all hospital stays for children in this age group.
■ Irritable Bowel Syndrome (IBS) alone affects almost 20 percent of the adult population in America.
■ One million Americans suffer from AIDS
■ Eight million have cancer
■ Twelve million battle heart disease.
■ Thirty-eight million Americans are victims of digestive disorders, including Crohn’s disease, ulcerative colitis, diverticulitis, celiac disease, IBS, constipation, diarrhea, GERD, candida and food allergies.
Functions of the GI System
■ Reduce complex nutrients into small units for absorption
■ Absorb subunit of nutrients into the blood and lymph
■ Remove toxins and germs that come in through the mouth or excretes via the bile
■ Chewing
■ Protein digestion and breaking down large food particles in the stomach
■ Carbohydrates and lipids digestion in small intestine--duodenum
■ Nutrients absorption in the small intestine--ileum
■ Immunity provided by HCl, SIgA, GALT
■ Nutrients manufacturing by friendly flora—vitamin K, biotin, short chain fatty acids, minerals released by fermentation of fibers—large bowel
■ Hormone conversion—rT3 to T3, vitamin D
■ Toxins disposal via bile
Immune Protective Factors in Saliva
■ Lactoferrin—fungicidal and bactericidal protein
■ Lysozyme—enzyme that digest bacterial cell walls
■ Hypothiocyanate—strong oxidizing agent against cell walls
■ Secretory Ig A– primary mucosal immunoglobulin
Digestion and Absorption
■ Protein digestion starts in the stomach and requires strong stomach acid.
■ Carbohydrate digestion starts in the mouth and finishes in the small intestine, by pancreatic enzymes.
■ Fat and fat soluble vitamins require bile to digest and absorb
■ Bile is produced by the liver, stored in the gall bladder, release during food digestion
■ Medium and short chain fatty acids do not need as much bile for digestion
The Second Brain (book by Michael D. Gershon, MD)
■ “A hundred million neurotransmitters line the length of the gut, approximately the same number that is found in the brain..."
■ Nearly every chemical that controls the brain in the head has been identified in the gut, including hormones and neurotransmitters.
2/17/09
The Brain Gut Connection
■ Patients with bowel problems tend to have abnormal REM sleep.
■ Poor sleep has been reported by many perhaps a majority of, patients with irritable bowel syndrome (lBS) and non-ulcerative dyspepsia (also known as "sour stomach") who complain of awakening tired and unrefreshed in the morning.
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The Brain Gut Connection
■ Abnormal REM sleep is reduced by low-dose treatment with the anti-depressant amitryptiline, which has also been shown to be effective in treating lBS and non-ulcerative dyspepsia.
■ About 25% of people taking fluoxetine (Prozac) and other types of similar-acting antidepressants experience gastrointestinal problems such as nausea, diarrhea and constipation.
-feeding friendly bacteria with poor-quality food can change them into pathological bacteria (they release toxic metabolites)
-antibiotics can also turn them into pathological forms
-chickens with pineal gland removed will often produce scoliosis (reduced melatonin)
-book “In Defense of Food” by Michael Pollan
Four Underlying Causes of Gastrointestinal Dysfunction
■ Pathogen associated GI complaints caused by:
■ Parasitic Infestations
■ Yeast Overgrowth (kids with autism or ADHD often have yeast pblm)
■ Fungal Infections
■ Normal Flora Imbalances
■ Bacterial Overgrowth/Infections
■ Neuroenteric related complaints caused by:
■ Dystonia of GI smooth muscle
■ Dysrhythmia of GI smooth muscle
■ Sympathetic to parasympathetic imbalance
■ Non pathogen related GI complaints caused by:
Acquired or genetically determined functional and structural GI complaints
■ External Stressors:
■ Dietary intolerances & allergies
■ Environmental factors
■ Pharmacological factors
Factors Affect GI Health
■ Toxins such as petrochemicals, heavy metals, organic compounds, food additives and drugs
■ Trans fatty acids
■ Pathological organisms overgrowth—yeast, fungi, virus, bacteria
■ Extreme Emotions—anger, fear, excitement, anxiety
■ Overeating
Other Factors affect GI Health
■ Malnutrition—protein, fat, vitamin, mineral, essential fatty acids
■ Food or drinks in extreme temperatures
■ Lack of sleep—affect the balance of GI flora and hormones
■ Dehydration—The GI tract produces more than 4 liters of digestive fluid daily
■ Lack of or excessive dietary fiber
■ Refined sugars in the diet—damage enzymes by glycation
Dysbiosis and Asthma
■ Is there a link between the explosive increases in asthma and allergies over the past four decades that have occurred in tandem with widespread increases in antibiotic use?
■ Antibiotics weaken natural bacteria in the gut and, stimulate overgrowth of the yeast Candida albicans.
■ Previous studies have shown that overgrowth of yeast adversely affects the body's mucosal immunity.
■ The result: A weakened immune system that becomes vulnerable to allergies and asthma.
Allergy and Immune Stress Study
■ In a University of Michigan study, mice were given antibiotics in their drinking water for five days to weaken their gut bacteria.
■ They were then injected with candida yeast, to mimic the response that antibiotics produce in humans.
■ Finally, the mice's nasal passages were exposed to aspergillus, a mold spore that is a common allergy trigger in humans.
■ The mice that received antibiotics showed increased sensitivity to the mold spore in their respiratory systems, whereas mice that did not receive antibiotics did not develop the sensitivities to mold.
■ This study reaffirms the concept that what goes on in the gut can play an important role in regulating immune responses--even in the lungs, since they too secrete mucus. And, to take the concept one step further, if a problem in the lungs is found to originate at another site in the body, there is possibility that other chronic diseases have their roots in the gut or other parts of the body not thought of previously.
-Increased incidence of pneumonia with the use of acid blocking drugs
Leaky Gut and Food Allergies
■ The widespread use of antibiotics and dramatic changes in the diet in industrialized countries have been accompanied by a striking increase in the incidence of allergies and asthma.
■ The natural flora of our bodies plays a significant role in regulating immune responses.
■ When normal flora in our GI fall out of balance, the body responds in imbalanced ways ( symptoms.
Drugs and Gut
■ Twenty percent of the patients received prescription drugs experience side effects
■ The drugs that most often caused complications were antibiotics, antidepressants, and NSAIDs.
■ The most often reported side effects were GI symptoms, sleep difficulties, fatigue and mood changes.
-Journal of General Internal Medicine 2000;15:149-154
■ SSRI-Prozac, Effexor, Celexa, Zoloft and paxil—have a threefold greater risk of upper GI bleeding than those who do not take these drugs
▪ Alain Li Wan Po. Antidepressants and upper gastrointestinal bleeding, British Medical Journal, Oct. 23, 1999;319:1081-1082, 1106-1109
Cox2 Inhibitors
■ Anti-inflammatory (pain killers) medications—Vioxx, Celebrex, Bextra
■ Thought to prevent GI bleeding, but recent data shows that they are not protective of the GI tract.
■ Increases the incidence of heart attacks.
■ Vioxx may have caused anywhere between 400 to 11000 heart attacks in older men according Dr. David Grahm’s report to the FDA panel.
■ Vioxx was voluntarily pulled out of the market by Merck, September, 2004, but a FDA panel of “experts” was recommending that it be put back on the market because the other two drugs—Celebrex and Bextra—were still being sold and they have the same problem as Vioxx?!? (New York Times, Feb, 18, 2005)
Disorders of the Upper GI Tract
(May interfere with chewing and swallowing)
■ Achalasia
■ AIDS
■ Alzheimer’s disease
■ Broken jaw
■ Cancer
■ Chemotherapy
■ Congenital defects
■ Dental caries
■ Dry mouth
■ Gullain-Barre syndrome
■ Head injury
■ Ill-fitting dentures
Disorders of the Stomach
■ GERD (Gastro-esophageal reflux disease)
■ Indigestion, dyspepsia
■ Gastritis
■ Hiatal Hernia
■ Peptic ulcers
■ Nausea and vomiting
GERD Prevention
■ Eat small meals and drink liquids an hour before and after meals, avoid stomach distension
■ Relax at mealtime, chew thoroughly, avoid swallow air
■ Limit foods that relax the LES
■ Avoid foods that are acidic, too hot or too cold
■ Maintain healthy weight
■ Avoid tight-fitting clothing
■ Avoid bending down lower than stomach
■ Stop smoking
■ Avoid spicy foods
2/20/09
Treatment of GERD
■ Most common cause of GERD is insufficient stomach acid production and delayed gastric emptying
■ Betaine HCl
■ Proteolytic enzymes
■ Active Manuka honey (helps to kill h. pylori)
■ Address ligament laxative problem
■ Address emotional stress
■ Don’t eat large meals when upset
■ Treat hiatal hernia with soft tissue manipulations, diaphragm
■ C3,4,5, mid thoracic, Psoas
The Lower Esophageal Sphincter
■ AKA cardiac sphincter, gastroesophageal sphincter
■ Substances that relax the cardiac sphincter:
●Alcohol
●Anticholinergic agents
●Calcium channel blockers
●Chocolate
●Diazepam
●cigarette
Hydrochloric Acid Secretion
■ Very energy dependent process—1500 Kcal per liter of gastric juices to concentrate the hydrogen ion to that concentration in the stomach
■ HCl produced in the parietal cells at pH 0.8
■ pH reaches 1.0—2.5 after mixing with the other gastric juices at the gastric lumen
HCl production
■ Chloride ion is actively transported into the parietal cells from the blood
■ Water is dissociated into hydrogen ion and hydroxyl ion
■ Carbon dioxide combines with the hydroxyl ion to form bicarb ion with the aide of carbonic anhydrase
■ Hydrogen ion combines with chloride ion to from HCl.
Signs and Symptoms of Hypochlordydria
■ Bloating, belching or gas w/in 1 hour of post eating upper GI
■ Bad breath (halitosis)
■ Fingernails chip, peel or break easily
■ Anemia unresponsive to iron
■ Sense of fullness after meals
■ Indigestion, diarrhea or constipation
■ Multiple food allergies
■ Nausea after taking supplements
■ Itching around the anus
Nutritional Physical Exam Findings
■ Adult acne
■ Dilated capillaries on nose and face
■ Dandruff
■ Soft, poor growth of fingernails
■ Brittle and splitting nails
■ White spots on nails (sign of zinc deficiency, Zn needed for HCl production)
■ Loss of taste or smell (sign of Zn def.)
Simple In-office Testing
■ Zinc taste test—use 2% zn sulfate solution, positive if can’t taste
■ HCl reflex—tenderness 1 inch below and to the left of xyphoid to the left edge of the rib cage
■ HCl Chapman Reflex—tenderness in the 6th intercostal space on the left rib cage in the mid-clavicular line
Other Tests
■ Urine Indican—Increased level is an indication of protein mal-digestion, increase microbial fermentation of protein in the lower bowel
■ Urine Sediment—Elevated uric acid residue due to poor protein digestion and hypochlorhydria
■ H. pylori infection
■ Other indications can be noted in blood chemistry test.
Blood Chemistry
■ Hypochlorhydria possible—Increased globulin level (>2.8 or 28 g/L) with a normal or decreased total protein (2.8 or 28 g/L) with increase BUN (>16 if 40g/L) decreased or normal total protein and or albumin and or decreased serum phosphorous
Other Blood Chemistry Indicators
■ Increased or decreased gastrin
■ Increased MCV and MCH
■ Decreased calcium
■ Decreased iron
■ Decreased chloride
■ Increased anion gap
■ AG=[Na+] - [Cl-] - [HCO3-]
■ Decreased alkaline phosphatase
Diseases Associated with Hypochlorhydria
■ Chronic dysbiosis
■ Diabetes mellitus
■ Childhood asthma
■ Thyroid problems
■ Skin problems
■ Hepatitis
■ Osteoporosis
■ Gallbladder Ds
2/24/09
Natural Therapy for Hypochlorhydria
■ Betaine HCl—150 mg with meals to begin with, build slowly to max of 1500 mg with each meal. If experience burning, neutralize with 1 tsp of baking soda in water or milk, cut back to comfortable level
■ Vinegar —start with 1 tsp of apple cider vinegar in water with each meal, build up to 10 tsp. Back off to comfort level if experience burning in the stomach
■ Vitamin B12 and folic acid (see note)
■ MVM
■ Digestive enzymes
■ Digestive Bitters
■ Herbs: Gentian, Scutelaria, Goldenseal
Patients with hypoHCl are more often than not deficient in B12 because of a decrease in HCL production from the parietal cells which lead to a drop in intrinsic factor production. Intrinsic factor is important for B12 absorption.
An MCV greater than 89.9 is common finding in B12 deficicency. Look for other indicator of B12 deficiency such as MCHC and RDW. If these levels are elevated above normal. Methylmalonic acid and homocysteine levels are more sensitive B12 status tests. If suspect B12 deficiency, 1000 mcg of B12 injection weekly for 4 weeks and retest. Long term treatment, use sublingual B12 lozenges to prolong the effects of B12 shots.
Hypersegmented neutrophils is sign of folic acid deficiency if found in microscopic blood smear.
If you see there is a concomittant high serum B12 and a high MCV and other signs of B12 deficiency, suspect a decreased function of MTHFR (methylenetrahydrofolate Reductase) which is essential for the methylation of folate and the conversion of cobalamin into methylcobalamin, an essential step in converting homocysteine into methionine.
Dietary Advise for Hypo HCL
■ Chew food thoroughly
■ Eat small frequent meals
■ Avoid drinking liquids with meals
The Myth of Acid Indigestion
■ 95% of the times, people with GERD does not produce enough stomach acids--hypochlorihydria
■ Rotten food in the stomach produces organic acids that are regurgitated into the esophagus--heartburn
Conditions Associate with N/V
■ Pregnancy
■ GERD
■ Esophagitis
■ Peptic ulcer
■ Gallbladder disorders
■ Pancreatic disorders
■ Kidney disorders
■ Cancer, chemo therapy
■ Delayed gastric emptying (diabetics)
■ Carbonate beverages
Minimize Nausea and Vomitting
■ 1-2 teaspoons of apple cider vinegar
■ Orthophosphoric acid
■ Avoid overeating
■ Use gallbladder support supplements—beet extract, bile salt replacement
■ Ginger tea, mint tea
■ B6 may be helpful for pregnancy related N/V
■ Lemon, Ume plum
Hiatal Hernia
■ Another reason for acid reflux
■ Overweight, smoking
■ Certain foods such as coffee, chocolate, hot spices, mint can relax the lower esophageal sphincter allowing acid to get up into the esophagus
■ Related to chronic ICV problem
Gastritis, Peptic and Duodenal Ulcer
■ Delay gastric emptying (gastroparesis)
■ Decreases mucous protection due to complex hormonal changes
■ Increases inflammation
■ Presence of Helicobacter pylori
■ Drugs that blocks acid production may lead to parietal cells atrophy.
Signs and Symptoms of H Pylori Infections
■ Discomfort in the upper GI especially the LUQ
■ Bloating
■ Nausea
■ Vomiting possible
■ Burning or pain int the upper abdomen an hour or so post prandial or in bed
■ Patient may have—Crohn’s disease, gastritis, peptic ulcers, rosacea
Associating Factors of Gastritis
■ Regular use of pain relievers—NSAIDS, aspirin, ibuprofen, naproxen
■ Excessive alcohol use—irritate and erode mucosal lining
■ Stress—suppress parasympathetic system, reduce mucosal integrity
■ Bile reflux disease—incompetent pyloric valve allows bile to flow into the stomach, neutralize acid and irritate lining lead to inflammation and chronic gastritis
Complications of Chronic Gastritis
■ Long-term effect: B12 deficiency mimic senile dementia
■ Test for serum B12, MCV, MCHC, homocysteine and methylmalonic acid levels
Signs and Symptoms of Gastritis
■ Normal or very frequent stools
■ Weak appetite
■ Epigastric pain worse or better with eating
■ Unexplained N/V
■ Fever at any temp
■ Blood in stools
■ Weight loss
Treatment for H. pylori
■ Medication: antibiotics
■ Natural treatments:
■ Gum Mastica (Pistacia lentiscus), 1-2 g per day for 2 weeks
■ Sulforaphane: Broccoli sprout concentrates
■ Deglycerized licorice (DGL): heal stomach lining
■ Herbs: myrrh, clove, anise seed, barberry bark, oregon grape root, wild indigo, cinnamon, oregano
■ Manuka honey
■ Probiotics
■ Bismouth
■ Treatment for hypo-HCl
Natural Treatment for Gastritis
■ Neem: antibacterial, anti-inflammatory, reduce stomach discomfort
■ Slippery Elm: soothing mucilage coats GI tract, part of “Roberts Formula”
■ Water: 4-6 glass during the pain
■ DGL: heal stomach lining
■ Aloe vera: sooth and heal GI lining
■ Gamma-oryzanol: in rice bran oil, heals GI lining, affects ANS to normalize gastric secretion
■ Cabbage juice: folk remedy for heartburn and ulcers, vitamin U for anti-ulcerative actions. 1 qt daily for 2 weeks
■ Zinc: 50-100mg per day
Robert’s Formula
■ Although it has never fully studied in placebo-controlled trials, it has long been used by natural doctors treating suspected inflammation in the GI tract. It sometimes contains bismuth, which kills H. Pylori, usually found in upper GI ulceration, as well as other microorganisms. Sooths inflamed mucosa, heals ulcers and reliefs dysbiosis
■ Cabbage leaf
■ Geranium
■ Marshmallow root
■ Slippery elm
■ Echinacea
■ Goldenseal
The 6R Program to Restore GI Health
■ Supplements and dietary change to
■ “Remove” pathological factors
■ “Reduce” negative dietary factors
■ “Restore” proper transit time
■ “Re-inoculate” Beneficial factors
■ “Replace” missing enzymes
■ “Repair” damages done to the GI tract, mucosal lining
Nutrition and The Digestive System—Part 3
Disorders of the Lower GI Tract
■ Diarrhea
■ Constipation
■ Irritable Bowel Syndrome
■ Gallbladder disorder
■ Fat malabsorption
■ Pancreatitis
■ Cystic Fibrosis
■ Crohn’s Disease
■ Dysbiosis
Inflammation and Gut Health
■ Inflammation is linked to all of these gut problems
■ Controlling inflammation is paramount in controlling these GI troubles
■ What are the causes of inflammation?
■ A typical American diet is pro-inflammatory
■ Stress-filled lifestyle for all ages
■ Stress cause the release of pro-inflammatory cytokines and chemicals
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Effects of Stress on the Body
■ Endocrine system: Adrenalin and other stress hormones are secreted. Cause sympathetic hyperactivity:
- Heart rate speeds up.
- Muscles tension increases
- Breathing rate speeds up
- Brain becomes extra alert!!
- Non-essential systems (immune and digestive) shut down temporarily
- Cortisol, causes more sugars to go into the circulation, by converting fat and proteins.
■ Increased risk for heart disease due to continued presence of stress factors
■ Immune system can become depressed increasing risk of diseases, and decreasing the body’s resistance
■ Digestive system: cramps, stomach aches, increased risk for ulcers, constipation, diarrhea
■ Mental Health
Immediate Response to Stress
The brain becomes more alert.
Heart rate increases.
Adrenal glands produce stress hormones.
Muscles tense.
Breathing quickens.
Digestive system slows down.
Effects of Chronic Prolonged Stress
Stress hormones can damage the brain’s ability to remember and cause neurons to atrophy and die.
Baseline anxiety level can increase.
Persistently increased blood pressure and heart rate can lead to potential for blood clotting and increase the risk
of stroke and heart attack.
Cortisol and other stress hormones can increase appetite and thus body fat.
Cortisol increases glucose production in the liver, causing renal hypertension.
Other Effects of Stress
Stress can contribute to headaches, anxiety, and depression.
Sleep can be disrupted.
Stress can contribute to menstrual disorders in women.
Stress can contribute to impotence and premature ejaculation in men.
Muscular twitches or “nervous tics” can result.
Mouth ulcers or “cold sores” can crop up.
The lungs can become more susceptible to colds and infections.
Immune system is suppressed.
Skin problems such as eczema and psoriasis can appear.
Stress can cause upset stomachs.
Stress, HPA dysregulation and GI Problems
■ Stress ( sympathetic over-activity ( depressed parasympathetic influence of the GI tract ( multiple GI disorders.
■ Reduced gastric acid production (reduce secretin and CCK( gallbladder suppression ( fat malabsorption ( Gallstone ( fat soluble nutrients deficiency ( depress normal physiology and indigestion due to digestive enzyme deficiency.
■ Malnutrition ( lowered immune function ( chronic infection and increase internal stress and maintain vicious cycles of illness
S/S Digestive Enzyme Deficiencies
■ Loose watery stool
■ Maldigestion
■ Post prandial abdominal pain
■ Stool with undigested food
■ Protein in stool
■ Acne (toxic liver)
■ Food allergies and intolerances
Diseases Associated with Pancreatic Enzyme Deficiencies
■ Diabetes
■ Cystic fibrosis
■ Chronic pancreatitis
■ Malabsorption
■ IBS
■ UC
■ IBD
■ Dysbiosis
Irritable Bowel Syndrome
■ IBS is a poorly understood condition relating to functional abnormality of the lower GI tract, 20% of the adults in the US suffered from it.
■ Symptoms: abdominal cramps, painful and explosive diarrhea, and/or constipation, mucous in the stool, bloating, gas, not able to completely empty bowel or feel like it is not completely empty
■ Diagnosed by ruling out physical causes
■ Since there is no known cause, there is no known cure—medications for symptomatic relief--antispasmodic, laxative, antidepressants
■ Certain foods can cause symptoms—sub-clinical gluten intolerance
■ Food sensitivity and dysbiosis are considered suspects by many alternative health professionals
■ Stress’ also considered as a major trigger
Symptoms of IBS
■ Abdominal distention, spasm and pain
■ Abdominal pain relief with defecation
■ Increase stool frequency
■ Alter stool consistency
■ Mucus in stool
■ Incomplete evacuation
■ Bloating and gas
■ Diarrhea and constipation alternate
2/25/09
Testing
■ To rule out organic disease such as Crohn’s, UC, cancer or parasitic infections
■ Work up for hypochlorhydria
■ Allergy and food sensitivity
■ Fatty acid profile: n-3 to n-6, imbalance linked to inflammation response
■ Lactose intolerance test--([hydrogen] in breath)
■ Disaccharides intolerance—mannitol. Sucrose, sorbitol, maltose
Tests
■ Highly level of methane in hydrogen breath test, indicates Clostridium difficile infection
■ CDSA with parasitology
■ Intestinal permeability test
■ Hormonal imbalance
■ Genetic factors
■ Psychological trauma or depression
IBS
■ Imbalance of gut hormones especially serotonin may be a key to solve the mystery.
■ Prozac can cause diarrhea and constipation depends on the dose.
■ The drug, Zelnorm acts as a serotonin agonist, stimulates GI tract motion
■ What in nature can cause an imbalance of the serotonin system? Any addictive stuff.
■ Sugar is universal.
Natural Therapy for IBS
■ Antimicrobial substances and herbs such as Grapefruit seed extract
■ Probiotics
■ Improve digestion
■ Avoid antigenic foods
■ Low-fat, high fiber diet
■ Natural anti-inflammatory herbs and functional food supl.
■ Herbal pain management
■ Repair the GI
Dysbiosis
■ Abnormal population of flora in GI tract
■ The overgrowth of harmful microbes in the oral cavity, GI tract or vaginal cavity
■ Common criminals: yeast, bacteria, parasites
■ E. coli, salmonella, giardia, blastocytisis, cryptosporidium, candida sp.
Dysbiosis Induces Diseases
■ Inhibit normal flora leads to nutrients deficiencies
■ Cause inflammation in the GI, vagina or sinus
■ Compromise nutrient absorption
■ Produce toxins increase liver burden
■ Decrease short chain fatty acid in colon thus increase risk of colon cancer
■ Produce trans fatty acids in colon
■ Leaky gut syndrome
■ Deplete B12 and some amino acids
■ Interfere with bile acid and estrogen elimination by deconjugating metabolites in bile and increase breast and uterine cancer risks
Causes of Dysbiosis
■ Antibiotics
■ Hypo-HCl
■ Presence of xenobiotics, chemicals and heavy metals
■ Parasitic and yeast infections
■ Pancreatic insufficiency
■ Slow GI transit time or stasis
■ Poor GI immune fxn, low SIgA
■ Nutrient deficiencies
■ Low fiber diet
■ Alkaline GI pH
S/S of Dysbiosis
■ Unexplained abdominal symptoms
■ Frequent stools
■ Intolerance to sugar, starch, fiber or probiotics
■ Odiferous flatulence
■ Bloating
■ Chronic fatigue
■ Headaches
■ Skin problems
■ Vaginal yeast infection
Diseases and disorders linked to dysbiosis
■ IBS, UC, IBD
■ Inflammatory and autoimmune dz
■ Food allergies and intolerance
■ Breast and colon cancer
■ Chronic fatigue and fibromyalgia
■ Atopic eczema
■ Pancreatic insufficiency
■ Leaky gut
■ Candidiasis
■ Endocarditis
■ Malnutrition
Conventional Treatment
■ Antibiotics
■ Antifungals: Diflucan
■ Antiparasitics: Flagyl
■ Probiotics
Natural Therapies
■ Grape fruit seed extract
■ Oregano oil
■ Olive leaf extract
■ Black walnut hull
■ Goldenseal
■ Wormwood
■ Bayberry
■ Enzymes
■ Probiotics—restore normal flora
Leaky Gut Syndrome S/S
■ Diarrhea
■ Cramping
■ Bloating
■ Flatulence
■ Weight loss
■ Steatorrhea
Tests for Leaky Gut Syndrome
■ The Intestinal Permeability Test: pre and post urine recovery samples with mannitol and lactulose challenge (Genova Diagnostics)
■ Mucosal Barrier Test (ImmunoSciences, Inc, Bio-Health labs)
■ SIgA (Diagnos-Tech, Bio-Health, Genova, Doctor’s Data) Stool and saliva samples
Natural Tx for Leaky Gut Syndrome
■ Restore Bowel Flora
■ Heal the GI lining: L-glutamine, butyric acid, fatty acid supplements
Biliary Insufficiency/Stasis S/S
■ Pain between shoulder blades
■ Greasy food upset
■ Steatorrhea, loose, bulky, odorus stools
■ Nausea
■ Motion sickness
■ Morning sickness
■ Dry itchy skin, peels on heels
■ Headache over eyes
■ Gallbladder attacks Hx
■ Bitter taste in mouth after meals
■ Dark orange urine
Physical Findings of Biliary Insufficiency
■ Dry scaly hyperemic ear canal with dark wax
■ Dry skin, hair
■ Red bumps on the elbow
■ Follicular hyperkeratosis
■ Xanthelasma on the eyelids
■ Xanthomas
■ Clubbing of the fingers
■ Murphy’s sign
■ Tenderness and nodulation on right thumb web
■ Pain over the gallbladder area at 6th intercostal space
Nutrients to thin the bile
■ Bile salt
■ Taurine
■ Pancreatic lipase
■ Vitamin C
■ Phosphatidylcholine
■ Lecithin (raw egg yolk is the best source of lecithin)
■ Choline and methionine (lipotropic factors)
■ Pancreatic enzymes
Cholagogues and antispasmotic
■ Artichoke leaf extract
■ Beets
■ Spanish black radish (high is sulfur – methyl glycine)
■ Dandelion root
■ Celandine
■ Milk thistle
■ Peppermint oil (enteric coated)—use on empty stomach, or use topically for difficulty passing stools with spasm
The Effects of Fat Malabsorption
[pic]
Lactose Intolerance
[pic]
Your Gut—The Drug Maker
■ According to a research from the University of Michigan, the human brain contains receptors for benzodiazepine, a drug that relieves anxiety, suggesting that the body produces its own internal source of the drug
■ Patients with liver failure, fell into a deep coma. The coma can be reversed, in minutes, by giving the patient a drug that blocks benzodiazepine.
■ Could depression be caused by a distressed gut releasing too much benzodiazepine?
Restore and Maintain Gut Health
■ The body is a self-regulating organism
■ There are lots more that our body can do than our conscious mind can ever comprehend
■ Innate intelligence
■ Our ancestors did not have to study what to eat or what medications to use
■ All they had to do was eat whatever mother nature provided for them—they stayed healthy
1. Eat wholesome natural, organically grown foods
2. Avoid all forms of processed foods, refined sugars and carbohydrates
3. Minimize exposure to toxic chemicals and metals
4. Get enough sleep, in total darkness
5. Eat enough, but not excessive fiber: vegetables, nuts, seeds, whole grains and fruits
6. Drink adequate but not excessive clean water, but don’t drink too much water with meals
7. Chew slowly and thoroughly (Fletcherizing)
8. Eat until only 80% satisfy
9. Do not eat while upset, worry or angry
10. Do not eat within three hours of bed time
11. Do not use drugs unnecessarily
12. Use probiotics or lacto-fermented foods to replenish friendly flora
13. Use coconut oil, raw cream or butter for their antimicrobial short and medium chain fatty acids
14. Avoid eating raw foods if any GI ailments present
15. Eat with relaxing music and with loved ones, in silence
16. Use nutritional, herbal and homeopathic supplements
17. Exercise regularly, but not after 5 pm
18. Avoid foods you are sensitive to
19. Sleep between 10pm to 6am regularly
The 4R Program
■ Jeffrey Bland, PhD, has outlined a natural course of care for these digestive complaints, called the 4R approach. It involves:
■ Removing infective organisms, which can be properly diagnosed with a stool analysis (CDSA Labs);
■ Reinnoculating the gut with friendly bacteria to completely reset the digestive and repair function.
■ Repairing the GI lining, often using proteins and fats;
■ Replacing digestive enzymes and acids to give your digestion a “help” initially
2/27/09
-theory behind homeopathy:
-in tiny quantities, an herb eliminates the symptoms that it would otherwise cause in a large quantity
-for example, in large quantities an onion causes cold-like symptoms (runny nose, eyes, etc)
-therefore, in very small quantities, onion can remove cold-like symptoms
The 6R Program to Restore GI Health
■ Supplements and dietary change to
■ “Remove” pathological factors
■ “Reduce” negative dietary factors
■ “Restore” proper transit time
■ “Re-inoculate” Beneficial factors
■ “Replace” missing enzymes
■ “Repair” damages done to the GI tract, mucosal lining
The 6R Program--Remove
■ Elimination of pathogenic microbs—yeast, parasites, bacteria, virus etc. that may be present, with plant enzymes, herbs, homoeopathic preparations, bioresonance therapy (Rife frequency generator) and ozone therapy.
■ Reduce sugar, refined carbohydrates, saturated fat, red meat. Increase dietary fiber and water.
■ Coconut oil, olive oil have antimicrobial activities
■ Research for herbs and nutrients that can remove microbial infestation
Antimicrobial herbs
■ Zymex (SP)—yeast
■ Zymex II (SP)—parasites
■ Articin (Thorne), Wormwood—parasites
■ Black walnut hull--parasites
■ Garlic—fungus, parasites, virus (soak garlic in apple cider vinegar for a few weeks)
■ SF722 (Thorne)— yeast
■ Enzymes, Cat’s claw, Olive leaf extract, coconut oil, grapefruit seed extract, oregano oil
■ Goldenseal, andrographus
The 6R Program--Reduce
■ Reduce negative dietary factors
■ Refined sugars
■ Refined flours
■ Additive and preservatives
■ Food antigens—gluten, dairy, lactose, soy
■ Specific diets
■ Specific carbohydrate diet
■ Anti-inflammatory diet
■ GFCF
The 6R Program--Restore
■ Restore proper intestinal transit time
■ Fruits and vegetables
■ Dietary fiber supplements
■ Essential fatty acid
■ Acidifying GI pH—lacto-fermented vegetables, vinegars and dairy
■ Home-made pickles, chutneys
The 6R Program—Re-Inoculate
■ Reintroduction of desirable gastrointestinal microflora
■ Lacto-fermentation
■ A good source of beneficial microbs:
■ Lactobacillus, bifidobacterium
■ Lactobacillus sporogenes
■ Hemostatic soil organisms (HSO)
■ Lacto-fermented dairy, vegetables, vinegars, Kombucha
■ Lactic acid yeast, Saccharomyces boulardii
Kombucha has been used for centuries in eastern lands as a valuable aid to good health. One of the earliest records goes back to approx. 447AD when a Korean physician named Kombu treated the Japanese nobleman Inkyo with the tea elixir. Such was its success that it rapidly spread from Japan to Manchuria, and into Russia. The name Kombucha is derived from Kombu, (the Korean physician) and Cha an eastern name for tea.
The Kombucha fungus (it is actually a lichen) has the unique ability to turn tea and sugar into a highly beneficial drink producing many essential acids whilst only producing a minute amount of alcohol. Kombucha elixir has the ability to de-tox the body, boost the immune system and improve energy levels.
It produces Glucuronic Acid useful for de-toxing and boosting the immune system, Usinic Acid useful in cases of Uria (gout) to rid the body of impurities, Lactic Acid, essential for a healthy digestive tract and Acetic Acid useful as an antiseptic and for inhibiting harmful bacteria.
It can also produce Citric Acid, Malic Acid, Butyric Acid, Amino Acids and almost all of the B complex vitamins. Kombucha brewing has gained in popularity in recent years in the west either by the batch method or more recently by the continuous fermentation process.
3/3/09
The 6R Program—Replace
■ Replacement of digestive factors and or enzymes whose intrinsic function maybe limited or inadequate. These substances facilitate the breakdown of foods to the basic molecular compositional units and/or their preparation for absorption.
■ Probiotics
The 6R Program--Replace
■ Betaine HCl
■ Bile salt
■ Beet root and leaves extract
■ Plant enzymes—bromelain, papaya enzyme, mold enzymes
■ Proteolytic/pancreatic enzymes
Pancreatic or plant enzymes, bile salts digestive herbs, Betaine HCI. (hydro-chloric acid) are some of the main replacement items. To aide digestion while repairing the GI tract, support digestive enzymes activities and gallbladder function.
The 6R Program--Repair
■ Repair refers to the provision of nutritional support for regeneration of the intestinal mucosa. The G.I. mucosal cells represent the largest mass of rapidly proliferating cells in the body of normal individuals. Damage can occur through chronic dietary insufficiency, food allergens, pathological infections, parasites, viruses, candidasis etc. Damaged mucosa leads to the syndrome we generally call "leaky gut". Think of the gut wall as a one-way fence, with small "holes" in it to allow the passage of nutrients. If they enlarge due to damage, toxins can pass through as well, thus damaging liver function, increasing bile, carcinogens, free radicals, ending up with systemic toxic overload, eczema, pancreatitis, gallstones, I.B.S., fatigue, arthritis, shortness of breath, poor exercise tolerance.
■ Treatment includes vitamin therapy, Vitamin C, E & A, Beta-carotene, Aloe Vera, Glucosamine and the remedies mentioned under the "Remove" section.
Anti-inflammatory and Pain management
■ Gamma-oryzanol
■ EPA/DHA
■ Artichoke leaf extract
■ Boswellia
■ Peppermint oil
■ Ginger
■ Turmeric
■ Antispasmodic herbs—chamomile, melissa, rosemary, valerian, skullcap, passion flower
The 6R Program--Repair
■ Herbs or nutrients that speed the healing of damaged gut mucosa
■ Slippery Elm bark
■ Aloe vera
■ Colostrum
■ Coconut oil
■ N-acetyl-cysteine (a precursor to the antioxidant glutathione)
■ L-glutamine
■ Quercitin (a bioflavanoid)
■ Folic acid
■ Gamma-oryzanol
■ Antioxidant vitamins—A, C, E
■ MVM
■ Zinc
Clear digestive problems first
■ Patients with marked GI symptoms
■ Lab test: stool analysis, food intolerance
■ Dietary recommendations
■ Supplements:
■ Antimicrobial herbs
■ Digestive enzymes
■ Probiotics
■ Nutrients that protect and heal mucous membrane
Caution
■ Do not recommend a liver detox for patients with severe GI disturbance
■ Patients must have normal bowel movements before engaging any detox program
Emotional Stress Relief
■ Techniques for emotional problems—NET, EFT (, )
■ Time management
■ Get together with friends
■ Practice forgiveness
■ Volunteering and reach out to others
■ Exercise—yoga, Taichi, breathing exercise
■ Hobbies
To learn more…
■
■
■ The Second Brain, Michael Gershon
■ Natural Ways to Digestive Health, Stephen Holt.
■ -- an ebook of taking responsibility of our lives.
■ Google “Inverse paranoid”
*always take care of the GI problem first
-herbs, nutrition, adjust, acupuncture, and soft tissue
Functional Approach to Endocrine Disorders (part 1) 3/4/09
Foods as Hormonal Signals from Nature
• Foods provide the chemical signals from nature to coordinate our micro-endocrine system
• Nutrients from real foods connect humans to the macro-endocrine system of the earth
• We are all One—children of Gaia
• Our ancestors had to eat according to seasons. (Isotopic Evidence for Dietary Variability in the Early Hominin Paranthropus robustus. Science, Nov 10, 2006, Vol. 314. no. 5801, pp. 980 - 982 )
-vegetables and fruits (foods high in water) tend to be yin (cooling)
-animal proteins (and cooked foods) are yang (warming)
-when we eat winter foods in the summer (like barbecue), then we’re more likely to get overheated
Clinical Endocrinology
• The branch of medicine dealing with the endocrine glands and their hormones
• Identify organs or glands that are deficient or non-functioning and use some type of pharmaceutical agent or hormone to replace, suppress or support the dysfunction glands
• Specific for certain genetic disorders and disease patterns that alter hormone production or functions pathologically
Functional Endocrinology
• Identifies alterations in the endocrine systems at subclinical states prior to the point of clinical diagnosis
• Typically not considered for treatment by conventional/allopathic medicine
• Subclinical problems are not considered diseases and left untreated
• Conventional blood and urine tests and reference ranges may not detect functional endocrine imbalances
• Left untreated, functional imbalance will progress to disease states
• Patients typically suffer from multiple organ dysfunctions, fatigue and depression for prolong period of time until objective measurements are evident in lab tests
• Increased risks for many disorders
• Example: Insulin Resistance
• Elevated blood pressure, dyslipidemia,
• Treated with statin for symptoms
• Increase risks for multiple organ disorders
• Culminate in diabetes, heart failure, obesity, CVD, PVD, eyes and kidney damages
• The sick gets sicker with more and more suffering before disease state is reached and thus “diagnosed”
• Understand and support a complex series of vicious cycles that feed each other
• Identify these pattern
• Provide nutritional support and counseling to unlock these vicious cycles
• Look for the root causes
• Not just identify symptoms and supply a magic pill to manage them
What is Functional Endocrinology?
Endocrinology is the branch of medicine dealing with the glands and their hormones. Functional endocrinology identifies abnormal alterations in the endocrine systems that are not in a diagnosible disease state. This is done by narrowing the blood work from the laboratory's normal range to the true "healthy" range which is a smaller margin within the lab range. For example, the normal lab range for thyroid stimulating hormone (TSH) is 0.5-4.5 however the 'healthy' range lies between 1.5-2.5. If your TSH is less that 1.5, and along with other clinical correlations, an astute clinician with the knowledge of functional endocrinology can suspect sluggish thyroid function with or without obvious symptoms to the patient!
People suffer from with many alterations in the endocrine systems that are not in a disease state, if not treated at the early signs of dysfunction may lead to pathology down the road. If these functional endocrine disorders are not diagnosed as abnormal and therefore are left untreated in the standard healthcare, these people will continue to suffer until manifestations of disease become apparent. These patients typically suffer from wide ranges of symptoms from, digestive problem, fatigue to severe depression.
Allopathic doctors are trained to diagnosed condition by look for signs and symptoms and then prescribe medicine for “it.” Functional endocrinology, however requires the detective work necessary to find the main culprit that leads to the signs and symptoms that the allopath prescribes medication for. For example, in the traditional endocrine model, patients that present with elevated blood pressure or cholesterol will be placed on pharmaceutical agents to alter the secondary changes that may take place from insulin resistance. In functional endocrine model, factors that change metabolism, altering physiological response will be evaluated first. An example of this is managing the primary concern of insulin resistance and looking for improvements in blood pressure and cholesterol values.
Functional endocrine disorders also increase risk for many disorders if untreated. In order to practice functional endocrinology, the clinician must understand the depth of human physiology and metabolism. Functional endocrinology involves understanding and supporting a complex series of vicious cycles that feed each other; therefore, the range of ailments assessed is wide and includes but is not limited to slow working thyroid (hypothyroidism), hypertension to high cholesterol, PMS to perimenopause, menopause to depression, fatigue to fibromyalgia, IBS to GERD, etc.
Steps in Managing Functional Endocrine Disorders
1. Understand the complex interactions of hormone metabolism
2. Select the appropriate laboratory test and follow up from the patient’s first visit and history
3. Understand the latest scientific research in the field of diet, nutrition, lifestyle and other non-invasive therapies
4. Properly educate patients to assure compliance to diet, lifestyle changes and supplement protocols
Vicious Cycles of Endocrine Imbalance
[pic]
Primary Physiology - Endocrine
Hormones and neurotransmitters are the first control system for homeostasis response – lifestyle and dietary stress can cause system-wide breakdown in hormonal balance
• Amino Acid based:
– Endocrine – Insulin, Glucagon, Somatohormone, Insulin-like growth factor (IGF), Thyroxin…
– Paracrine, pineal & neurotransmitters– Melatonin, Acetylcholine, Dopamine, Serotonin…
• Cholesterol based:
– Steroid endocrine – Cortisol, DHEA, Estrogen, Progesterone, Testosterone,
• Fat based:
– Autocrine – Eicosanoids, Prostaglandins
3/6/09
Different mechanisms of cell signaling Prostaglandin synthesis and related compounds
[pic] [pic]
Chemical structures of the three major classes of human hormones
Functional Endocrine Analysis
• Hormone Synthesis
• Hormone transport
• Hormone peripheral conversion
• Hormone detoxification
• Hormone receptor binding
• Intercellular transduction
• Transcription and proteomic response
Hormone Synthesis
• Secondary defects to hypothalamus pituitary function
• Drugs and synthetic compounds that inhibit synthesis
• Antibody reaction that inhibit function
• Lack of nutrients or cofactors that impact synthesis or release
Hormone Peripheral Conversion
• Synthetic compounds and drugs that impact binding hormones
• Hormones that impact binding proteins
• Natural compounds that alter binding proteins
• Organ dysfunction impairs hormone conversion and activation
Hormone Detoxification
• Phase I—oxidation/reduction
• Phase II—hydroxylation, sulfation, sulfoxidation, glucoronidation, methylation, glutathione conjugation, amino acid conjugation
• Drugs and synthetic compounds that impact detoxification
• Natural compounds that alter detoxification
• polymorphisms
Polymorphism (Biology). The occurrence of different forms, stages, or types in individual organisms or in organisms of the same species, independent of sexual variations. (genetics)The existence of a gene in several allelic forms
Hormone Receptor Binding
• Drugs and synthetic compounds that alter binding
• Natural compounds that alter binding
• Polymorphism
• Hormones and intercellular mediators that alter binding
• Intercellular mediators that alter transduction
• Transcription and proteomic response to cell response
Laboratory Analysis for Hormones
• Saliva tests
– less expansive
– non-invasive
– free fraction of hormone
– measure circadian rhythms and entire menstrual cycle
– unable to test for binding globulin
– not available for all hormones
– Lack of general understanding of their application and interpretation by the allopathic community
• Serum tests
– More expansive
– Required the service of a blood draw
– Measure all hormones bound to protein which do not give the amount of free active hormones
– Do not differentiate the bound and free hormones—no information on the actual hormone activity
– Serum free hormone tests are costly
– Reference ranges varied between labs and includes patients with pathological levels calculate as averages
Lab Analysis cont…
• Urine tests
– Measure hormone metabolites after they have passed detoxification
– Not reliable to determine the amount or rate of hormone produced by the organs or glands
– Amounts detected is altered by the rate of liver detox and kidney clearance in the individual
– Estrogen metabolites can be used to determine the risk for estrogen proliferative disorders
– Bone markers for assess bone metabolism
– Neurotransmitters
• Hair Analysis
– Measure physiological minerals in hair
– Magnesium, calcium, potassium, sodium, zinc, copper and phosphorus
– Ratios of specific minerals indicate endocrine functions
– Intracellular assessment
– Indication of disease process in the making or imbalance in endocrine function before reaching disease state
– Non-invasive and inexpensive
– Provides easy monitoring on an ongoing basis
Hair Mineral Ratios
• Ca/Mg (6.67:1) indicates pancreas function
• Ca/K (4:1) indicates thyroid function
• Na/Mg (4.17:1) indicates glucocorticoid function
• Na/K (2.50:1) indicates mineral corticoid function
• Ca/P (2.5:1) indicates protein utilization and absorption balance
• Zn/Cu (8:1) indicates sexual hormones balance
Types of Salivary Hormone Profiles
• Adrenal Stress Index (ASI)—circadian cortisol rhythm in a single day
• Short Post Menopausal Panel (PHP1)—baseline female hormones levels of one random sample, for those on HRT
• Long Post Menopausal Panel (PHP2)—two saliva samples separated by 5-7 days
• Expanded PHP1—include the measurement of pituitary hormones, for those that are NOT on HRT
• Pre Menopausal Female Hormone Profile (FHP)—11 samples during one menstrual cycle
• Expanded Pre Menopausal Female Hormone Profile (eFHP)—include pituitary hormones
• Male Hormone Panel (MHP)
• Expanded Male Hormone Panel (eMHP)
Prioritizing Patient Evaluation and Management
1. Identify and manage any and all gastrointestinal disorders, food sensitivities and bowel dysfunctions
2. Identify and manage adrenal and blood sugar disorders
3. Identify and manage any alterations in liver detoxification
4. Identify and manage any imbalances in essential fatty acid metabolism
5. Identify and manage any significant deficiencies in B-complex, trace minerals and magnesium—indicated by the amount of refined carbs consumption by patients.
Growth of Physicians and Administrators 1970-2005
[pic]
This chart helps us explain why we can spend so much more for so much less. Among the nations we just looked at, all of them have take the fundamental step of rejecting the financing of care by for-profit insurance companies, except for the United States.
The natural market behavior of insurance companies is to compete to cover healthy, profitable people while shunning anyone who actually needs care. To do this, they erect massive bureaucracies with no purpose other than to fight claims, issue denials and screen out the sick. They consume care dollars, but their main output is paperwork headaches. In response, hospitals and doctors’ offices must employ armies of administrators to deal with the separate payment bureaucracies of thousands of different insurance companies. U.S. businesses are saddled with the costly burden of administering their own health benefits. Co-payment collection and processing, eligibility determinations, utilization reviews: the scope of the bloat is staggering.
This slide begins to give a idea of the explosion of administrative waste within our health system.
Adrenal Stress Syndrome
The stressed-out-burned-out dragged-out-all-frazzled syndrome
What Do These Diseases Have in Common?
• Multiple Sclerosis
• Ulcerative Colitis
• Atherosclerosis
• Hydrochloric Acid Deficiency
• Constipation
• Periodontal Disease
American Psychological Association
• Forty-three percent of adults suffer adverse health effects from stress.
• Two-thirds of all office visits to family physicians are due to stress-related symptoms.
• Stress is linked to the six leading causes of death—heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide.
Foundation for Integrated Research In Mental Health
• Globally, more than 3 out of 5 doctor visits are for stress related problems.
Endocrine System
• HPA axis is the key to health and resilience, which is another word for health
• It should be called the “HPTPAG” axis as the entire endocrine system that organized core health
• Foundational health rests upon this endocrine axis as the most important element of a stable resilient system capable of modulation in response to need/stress
What Is Stress?
• A physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation.
3/10/09
How We React To Stress
• What We Eat
• How We Digest
• How We Assimilate
• How We Eliminate
• What We Do
• How We Breathe ( shallow breathing mimics the stress mechanism (signals brain that we are stressed)
• What We Think
• What We Inherit
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Adrenals Hormones
Adrenal hormones/actions:
➢ Medulla - Epinephrine/Norepinephrine – fight/flight
➢ Zona Reticularis – DHEA, Pregnenelone, Progesterone, Estrogen, Testosterone, Androstenidione – Antioxidant, repair, sex hormones, cortisol balance, anti-aging
➢ Zona Fasciculata – Cortisol – glycemic regulation, anti-inflammatory, immune response, vasculature tone, CNS stimulation, stress reaction normalization
➢ Zona Glomerulosa – Aldosterone – Regulation of Na, K, and fluid
Adrenal Functions
• Hormone production—stress response
– Adrenal cortex hormones: cortisol, aldosterone, progesterone, DHEA
– Adrenal medulla hormones: epinephrine and norepinephrine
• The ability of the adrenal glands to secret reproductive hormones after menopause will have a dramatic effect on how a women experience menopausal symptoms related to diminishing sex hormone production by the ovaries
Adrenal Cortex Hormone Pathways
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The Adrenal Stress Response
• Alarm reaction
– Initial response
– Hyperfunctional
– Increased cortisol with normal DHEA
• Resistance stage
– Prolonged stress
– “Prenenolone steal”
– Increased cortisol with low DHEA
• Exhaustion Stage
– Adrenal cannot adapt to stress—final stage
– Normal cortisol with low DHEA, hyper or hypo with normal DHEA, when depleted, low cortisol and low DHEA, finally, low cortisol and normal DHEA
Adrenal exhaustion progresses in three stages
• Stage I is distinguished by an increase in output of ACTH by the anterior pituitary gland, increased adrenocortical stimulation, increased cortisol output and an increased probability of pregnenolone steal and decreased DHEA. Generally in Stage I cortisol increases and DHEA and its metabolites decrease or an imbalance occurs especially between testosterone and estrogen.
• Stage II Adrenal Exhaustion is marked by the transition from increased to decreased cortisol output. This stage is characterized by continuing high levels of ACTH and thus: adrenocortical stimulation, normal total cortisol output, low or borderline low morning, noon or afternoon cortisol levels, normal nighttime cortisol level, and an increased probability of pregnenolone steal and a further decrease in DHEA. This is a transitional phase in which although ACTH stimulation remains high or even increases, the adrenal output of cortisol declines due to the adrenal fatigue associated with continued hyper stimulation.
• Stage III Adrenal Exhaustion is an advanced stage of adrenal exhaustion characterized by decreased total cortisol output. This stage is characterized by continuing high levels of ACTH and thus adrenocortical stimulation, low total cortisol output, and increased probability of a low nighttime cortisol level and pregnenolone steal and even further decrease in DHEA.
• The adrenal glands are now exhausted to the point that even though there is ongoing hyperstimulation (high ACTH); they continue to lose their capacity and reserve to produce enough cortisol. The eventual result is a crash of the hypothalamic-pituitary-adrenal axis (HPAA) in which essential neuroendocrine feedback loops are unable to return the system to homeostasis.
• During a high stress situation, levels of sIgA decrease. Secretory IgA protects the gut from pathogenic material. Chronic cortisol elevation may be associated with high antigliadin antibodies (gliadin is a protein component found in wheat) due to intestinal hyperpermeability.
Cortisol Activity in Body
• Increases glucose formation, and protein breakdown
• Increases glucose utilization by the CNS
• Increases "insulin resistance" in peripheral system
• Suppresses gastric emptying, slows digestion
• Inhibits sex hormone effects and production, alters reproduction
• Increases sodium retention — high blood pressure
• Suppresses immune function
• Alters thyroid function, production, and effectiveness
• Depletes the body of Magnesium, Zinc, Glutamine, Carnitine, etc
Cortisol protects the cell from:
➢ Excess insulin
➢ Inflammatory reactions
➢ Electrolyte imbalance (Na, K)
➢ Cell dehydration
➢ Cell damage
➢ Auto-immune reactions
➢ Deficient blood glucose
Adrenal fatigue/ Inadequate cortisol:
• Auto-immune reactions
• Deficient glucose
• Deficient energy production
• Deficient enzyme production
• Decreased cellular repair
• Increased cell damage
Adrenals – Known and as yet unknown
• Adrenal fatigue AKA Sub-clinical hypoadrenia, Hypoadrenia, Non-Addison’s hypoadrenia, Sub-clinical adrenal exhaustion, Neurasthenia, Hypocortisolism, Functional Hypoadrenia
• Total depletion of the adrenals is called Addison’s Disease and can be fatal but rare
• When the adrenals cannot keep pace with the demands placed upon them by the total amount of stress, it produces a condition called Adrenal Fatigue
• Adrenal fatigue first observed and recorded in 1898 in France by Emile Sargent as a sequelae to influenza
Frequency of Adrenal Fatigue
• “For the sake of credibility we have previously stated that about 16% of the population has some moderate to severe degree of hypocortisolism with hypoglycemia, but in actuality, the figure should read 67%, if all the arthritics, asthmatics, and hay fever sufferers, alcoholics and other elated groups were included.”
J. Tintera, Hypocortisolism – Adrenal Metabolic Research Society of the Hypoglycemia Foundation, 1974
3/11/09
Adrenal fatigue incidence -
… hypocortisolism appears to be a frequent and widespread phenomenon
C. Heim, Psychoneuroendocrinology, 2000 Jan; 25(1):1-35
80% of Americans are suffering from adrenal fatigue, and the other 20% are in denial!
John Morganthaller, 2002 – author of Smart Drugs I&II
Hypoadrenia Associated Conditions
• Fibromyalgia
• Chronic Fatigue Syndrome
• Rheumatoid Arthritis
• All autoimmune diseases (3,000)
• Cancer survival
• Asthma, Respiratory ailments
• Influenza
• Most diseases for which cortico-steroids are administered as treatments
– If a condition responds to steroid tx, it is associated with adrenal fatigue
Hypoadrenia and Clinical Conditions
• Immune down-regulation
• Cardiac myasthenia (inotrophic & chronotrophic)
• Loss of stamina/resilience
• Emotional paralysis
• Jet lag
• Altitude Sensitivity
• Declining athletic performance
• Post Traumatic Disorder Syndrome (PSTD)
• Sexual dysfunction, Libido loss
• Increased perimenopausal/menopausal condition
• Premenstrual tension, especially depression
• Depression – Loss of motivation, collapse after bad news, overwhelmed
-ginseng increases cortisol output (used in chronic wasting/fatigue diseases)
-getting frequent colds (coryza) is a form of adrenal fatigue
-too much cortisol can shut down your thinking cortex
Adrenal fatigue in PMS
• Women who were significantly more depressed premenstrually showed significantly lower cortisol levels on the premenstrual day as compared to the postmenstrual day
• Across the menstrual cycle, women who were significantly more depressed premenstrually also had lower evening cortisols in their premenstrual phase
J. Odber at al, Psychosomatic Research, 1998 Dec; 45(6):557-68
The Heart of Cortisol
– Cortisol concentration after out-of-hospital cardiac arrest are lower than those concentrations reported in other stress states
– There is an association between cortisol concentrations and short-term survival after cardiac arrest. Survivors have significantly greater increase in serum cortisol concentrations than non-survivors during the first 24 hours
– Lower than expected cortisol concentrations for the extreme stress of cardiac arrest may have pathologic significance in the hemodynamic instability seen after return of spontaneous circulation
– The etiology of low cortisol concentrations may be primary adrenal dysfunction
C H Schultz et al, Critical Care Medicine, 1993 Sep; 21(9): 1339-47
Adrenals & Survival
• Adrenal dysfunction is common in high-risk ER patients. Overall it has a frequency of 19% among a homogenous population of hemodynamically unstable vasopressor-dependent patients
-Emanuel Rivers et al, Academy of Emergency Medicine, 1999, Volume 6 (6), 626-630
• These results indicate that adrenal dysfunction is common among a group of critically ill patients seen in this hospital ER.
-SS Chang, Academy of Emergency Medicine, 2001 July; 8(7):761-4
• The greater the adrenal fatigue, the less likely one will survive cardiac arrest or other life-threatening situations.
-James Wilson, Adrenal Fatigue
Hyperadrenia
• Elevated cortisol suppresses TSH, inhibits the conversion of T4 to T3, and increases the conversion of T4 to rT3
• Cortisol reduces progesterone levels in primates, impairs endometrial secretions, increases estrogenic stimulation of endometrium
• Cortisol interrupts testosterone, progesterone, DHEA, T3 and estradiol
-too much estrogen can cause endometriosis, fibroid production, or uterine/ovarian cancer
Cortisol Imbalance S&S
• Fatigue
• Headache with physical or mental stress
• Weak immune system
• Allergies
• Slow morning start
• Gastric ulcer
• Afternoon headache
• Weight gain
Epinephrine Function
• Epinephrine causes transient hyperglycemia by activating enzymes whose actions promote gluconeogenesis and glycogenolysis in the liver while inhibiting glucose breakdown.
• Epinephrine decreases glucose uptake in the muscle and other organs and decreases insulin release from the pancreas.
• The decrease in insulin release prevents glucose from being taken up by the peripheral tissue and thus preserves it for the CNS.
• Epinephrine mobilizes free fatty acids and cholesterol by stimulating lipolysis, freeing triglycerides and fatty acids from fat stores, and inhibiting the degradation of circulating cholesterol to bile acids.
• Epinephrine increases oxygen supply, bronchodilation and increased ventilation.
• Epinephrine decreases protein synthesis
-adaptogens help to balance the hypo/hyper adrenal function
-deep breathing tells your brain that you are not stressed
Norepinephrine
Norepinephrine rarely if any reaches distal tissue and principally is involved in the regulation of blood pressure.
• It is the primary constrictor of smooth muscle in all blood vessels.
• During stress, norepinephrine raises blood pressure by constricting peripheral vessel, inhibits gastrointestinal activity and dilates the pupils of the eyes.
Catecholamine Activity in the Body
• Increases HR, return of blood to heart, cardiac output, and blood pressure
• Dilates blood vessels of skeletal muscle
• Increases blood sugar — promotes glucose formation
• Decreases Insulin release from the pancreas
• Prevents glucose uptake from peripheral tissues
• Increases FFA's and cholesterol in bloodstream
• Overall effect is to conserve energy for the Central Nervous System, and skeletal system for proper body function in relation to a stressful situation.
Catecholamine Imbalance S&S
• Dizziness from recumbent position to standing
• Transient spells of dizziness
• Asthma
• Hemorrhoids associated with hepatic portal congestion and poor Venous return
• Varicose veins
• Ragland Test
Aldosterone Imbalance S&S
• Rough sandpaper tongue=dehydrated
• Excessive urination, up to 15-20 times per day (may also be a thiamine deficiency or a hypertrophic prostate)
• Excessive perspiration or perspire with little or no activity, night sweat
• Paradoxyl pupillary light reaction
• Non-pitting edema of the extremities
• Crave salt
• Tinnitus
Adrenal Stress Syndrome Impact on Physiology
• Elevated cortisol will down-regulates insulin receptors and induces insulin resistance
– Hyperinsulinemia and CVD
• Decreased cortisol will un-stabilize blood sugar levels—hypoglycemia cannot be corrected unless the adrenal are normalized
• Adversely impacts HPA axis, binding of thyroid hormones, peripheral thyroid hormone conversion and thyroid detox pathways
• Elevated cortisol suppresses the enzyme 5’diiodinase, prevents the conversion of T4 to T3
• Lower thyroid function
• Elevated cortisol or increased steroid hormones suppresses the HPA axis
• TSH below 2.0
• Reduced or absent sex drive
• Increase ability to eat sugars without symptoms
• Abnormal thirst
• Amenorrhea
• Weight gain around the hips and waist
• Blunted ACTH response
• Elevated cortisol suppress the bodies detoxification system
• Cortisol overloaded the detox pathways:
– Skin blanching with pressure
– Acne or acne worse at menses
– Constipation
– Bloating
– Sensitivity to medication, supplements
– Unresponsive to endocrine support
Adrenal Stress Syndrome Impact on Physiology cont…
• Elevated cortisol suppresses SIgA in the GI tract
• Delays mucosal cell regeneration
• Promotes GI inflammation
• Contributes to leaky gut and dysbiosis
• Chronic yeast infection
• Suppresses the immune system
• Gastric ulcer and duodenal ulcers
• Inhibits bone production—osteoporosis
• Insomnia due to blood sugar imbalance or elevated cortisol just before bedtime
• Reduce RAM sleep
• “Elevated evening cortisol levels in late life probably reflect an impairment of the negative feedback control of the HPA axis in aging” JAMA Aug. 2000
• Elevated cortisol has been associated with neurodegenerative disorders
• “The degree of HPA axis hyperactivity is related significantly to the clinical course of MS.” –Neurobiology 1999;53:772-777
• Hippocampal cell destruction due to excitotoxicity of cortisol sensitive hippocampal cells
• Induce glial cells to produce inflammatory cytokines and neurotoxic agents (NO, free radicals), damage neurons and cause apoptosis—gliosis
• Increase CVD
– Stress increase blood pressure (catecholamines)
– Alters mineralcorticoid metabolism
– Suppresses DHEA synthesis
– Vasoconstriction
– Sodium retention
– Loss of potassium
– Insulin resistance
– Hypertriglyceridema
– Obesity
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Find the root causes
• Rule out Gastrointestinal Infections
• Rule out Gluten Intolerance
• Rule out Toxic Heavy Metals
• Rule out Toxic Chemicals
• Rule out Viruses
• Rule out Molds and Mycotoxins
• Rule out Oral Infections
Nutritional Management of Adrenal Stress Syndrome
• Adaptagenic herbs:
– Panex ginseng
– Siberian ginseng
– Ashwagandha
– Holybasil leaf
– Rhodiola
– Licorice root
– Boerhaavia Diffusa
Adaptagenic Herbs
• Herbs that normalize impact on the HPA axis under stress, defined by Russian pharmacologist, I.I.Berkman in 1957:
1. Must be harmless and cause minimal problems in physiology
2. Non-specific in function to increase resistance to negative influences by a wide range of stressors—chemical, physical, emotional
3. Normalizes irrespective of the direction of the pathological state
• Useful in both adrenal hyper- and hypo- functions
Adaptagenic Herbs
• Panax Ginseng—Korean ginseng, enhances fatty acid oxidation during exercise, conserve glycogen, increase O2 supply to working muscles, improve stemina, energy and physical work, reduces immune suppression caused by cortisol
• Siberian ginseng—enhances athletic and mental performance during stress situations
• Ashwagandha—Indian ginseng in Aryredic medicine, similar activity to panax ginseng
• Holybasil leaf Extract—prevents hypercortisolemia caused by stress, antagonized histamine, normalizes blood sugar and HPA axis activity, immune system and gastric mucosal protective
• Rhodiola rocea—enhances CNS, antidepressant, anticarcinogenic, cardioprotective, physical endurance, improve cognitive and mental functions
• Boerhavvia diffusa—support both hyper and hypo- adrenal function, buffer the elevations of serum cortisol and prevent immunosuppression, enhance cortisol levels with end stage adrenal exhaustion.
• Licorice root—glycerrhizin, restores exhausted adrenal function, prevent cortisol breakdown by down-regulate 11-beta-hydroxylase, increase the half-life of cortisol in serum, support the immune system, anti-allergic and anti-inflammatory
Boerhaavie Diffusa:
Useful Parts: Root, leaves and seeds.
Medicinal Uses: According to Ayurveda, Punarnava is bitter, cooling, astringent to bowels, useful in biliousness, blood impurities, leucorrhoea, anaemia, inflammations, heart diseases, asthma, alternatives etc. The leaves are useful in dyspepsia, tumours, spleen enlargement, abdominal pains. According to Unani system of medicine, the leaves are appetizer, alexiteric, useful in opthalmia, in joint pains. Seeds are tonic expectorant, carminative, useful in lumbago, scabies. The seeds are considered as promising blood purifier.
Nutritional Management of Adrenal Stress Syndrome
• Nutritional factors
– Pantethine—B-complex, lowers and raises cortisol as needed
– Phosphatidylserine (PS)—endogenous phospholipid, synthesis depends on commonly deficient nutrients (B12, folic acid, S-adensylmethionine [SAMe], EFA), enhance cellular communication and metabolism, anti-oxidant, decrease anxiety, antidepressant, memory and cognition, lowers cortisol, neuroprotective, trans-dermal delivery may be better than oral delivery bypassing the GI mucosa
– MVM
– Essential fatty acids
Lifestyle Changes Adrenal Stress
• Improve digestion
• Stabilize blood glucose
– Do not skip breakfast
– Eat a high quality protein based breakfast
– Snack on low glycemic foods—proteins
– Avoid concentrated sugars—refined sugars, fruits and carrot juices
– Avoid adrenal stimulants
– Eat well balanced meals—whole food, vegetables, meats and whole grains
– Eat frequent small meals
• Exercise in aerobic heart range
– Low impact aerobic
– Yoga
– Weight lifting
– Walking
– Swimming
– Cycling
– Taichi
– If you still feel tired after 24 hours, you overdid it.
• Avoid adrenal stimulants
– Refined sugars
– Caffeine
– Nicotine
– Alcohol
– Allergic foods
– Trans fat
– Artificial sweeteners (excitotoxins)
– pollutions
– Overtraining
– Inadequate sleep
• Stress management
• Wholesome diet
• Relaxation techniques
• Body work
• Adequate sleep, 8 or more hours
• Chiropractic adjustment
• Acupuncture
• Emotional energy techniques
Endocrine Disorders (part 2)
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■ Hypoglycemia
■ Abnormal weight gain or loss
■ GERD
■ Bloating
■ Dysbiosis (abnormal population of flora)
■ IBS
■ UC
■ Short-bowel syndrome
■ Celiac Disease
■ Diverticulosis
■ Diverticulitis
■ Inflammatory bowel disease—ulcerative colitis
■ Cancer
■ Resections of large intestine
■ Vomiting blood
■ Bloating
■ Belching
■ Hiccups
■ Intolerance to spicy foods
■ Feeling of fullness in upper abdomen after eating
■ Chronic autoimmune disorders
■ Myasthenia gravis
■ Urticaria
■ Adn after eating
Chronic autoimmune disorders
Myasthenia gravis
Urticaria
Adrenal exhaustion
■ Chronic atrophic gastritis
■ Chronic candida
●Garlic
●high-fat foods
●Meperdine
●Onions
●Peppermint and spearmint oils
●theophylline
■ Allergies
■ Eczema, psoriasis
■ Migraine headache
■ Malnutrition
■ Depression and anxiety
■ MS
■ Missing or no teeth
■ Myasthenia gravis
■ Oral surgery
■ Parkinson’s disease
■ Peridontal disease
■ Radiation therapy
■ Temperature sensitivity
■ Strokes
■ Surgery
■ ulceration
GI Laboratory Tests
■ Intestinal permeability test, aka lactulose and mannitol challenge test
-If lactulose in urine, then leaky gut
■ SIgA Food Sensitivity Test
■ Helicobacter pylori Test
■ Comprehensive Digestive Stool Analysis
■ Oxidative Stress Test
• Crave sweets, caffeine, nicotine
• Blurred vision, unstable behavior and mood
• Shaky and lightheaded if hungry
• Irritable before meals
• Eating relieves fatigue
• Cannot stay asleep or fall asleep
• Potassium excess
• Sodium loss
• Electrolyte imbalance
• Cell dehydration
• Insulin excess
• Poor wound healing
• Increased susceptibility to infection
• Alcoholism & Drug addiction
• Burnout
• Hypoglycemia
• Allergies
• Environmental Sensitivities
• Unresponsive hypothyroidism
• Sugar Craving
• Estrogen Dominance
• Weakened Immune System
• Obesity
• Coronary Disease
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