Intro to GI disorders



Intro to GI disorders

1. A web-like link of systemic disorders to the GI tract

2. Traditional treatment of GI problems relies on drugs such as anti-inflammatory agents, antacids, enteric nervous system inhibiting agents.

a. These approaches do not seek to uncover the underlying causes or triggers.

b. Suppressing symptoms rather than improving functions of the GI tract often lead to further deterioration.

c. Close interrelationship the GI tract plays with every major system in the body

3. GI-Immune, Pain, Inflammation

a. Over 60% of human immune system is in the GI tract

b. 99% of the body’s neurotransmitters

c. Any adverse antigen that interacts with gut-associated lymphoid tissue (GALT) will trigger inflammatory response

d. Lead to production of inflammatory mediators causing pain, inflammation and vasoconstriction

e. GI dysfunction is commonly found in patients with any chronic pain.

f. 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

4. Functional Hypothyroidism and the GI Tract Dysbiosis

a. 20% of active T3 is dependent upon a healthy gut microflora

b. Imbalance gut flora can cause decreased T3

c. Gut dysbiosis put stress on the adrenal glands ( cortisol

d. Cortisol can shift T4 into higher % of inactive T3 rather than active T3

5. GI Dysfunction and Autoimmune Disorders

6. GI Disorders and Adrenal Stress

a. HPA axis involvement when GALT is activated

b. Adrenal alarm response

c. Decrease DHEA ( reduce other steroid hormone production

d. Potential shift away from anabolic to catabolic state

e. Sub-clinical GI sensitivities to food antigen are major cause of adrenal stress and often undetected, unsuspected

f. Elevated cortisol suppress GI mucosa regeneration, decreases IgA ( increases dysbiosis

7. GI Dysfunction and Adrenal Stress

8. GI Dysfunction and Estrogen Dominance

a. Dysbiosis increase Beta Glucoronidase activity

b. Uncoupling conjugated estrogen

c. Reactivate estrogen and increase total estrogen load and liver stress

d. Ratio of 2-OH and 16-OH estrogen imbalance toward increase risks of reproductive organs cancers

9. GI Dysfunction and B-12 Deficiency

a. Megaloblastic anemia

b. B12 absorption is dependent on HCl in stomach, pancreatic enzymes and healthy brush border

c. Increase serum homocysteine , an inflammatory marker

d. Emotional and psychological signs and symptoms

10. GI Dysfunction on Moods and Depression

a. Decreases neurotransmitters synthesis and glucose absorption

b. enteric system produces 99% of serotonin (5HT)

c. Abnormal glucose absorption may cause glycemic dysregulation and impact mood, behavior and emotion controls

11. GI Dysfunction and Weight Control

a. can disrupt intercellular communication and make weight loss difficult

b. cytokines can prevent lipolysis and increase lypogenesis

12. Leaky Gut and Food Sensitivities

a. Healthy GI tract has tight junctions between enterocytes to prevent absorption of large food molecules.

b. During chronic inflammation or stress, tight junctions may be breached allowing large food molecule to enter bloodstream

c. Triggering histamine, leukotrienes, postanoids and PGs leading to food allergies.

13. GI Dysfunction and CVD

14. GI Dysfunction and Neurodegenerative Disorders

15. GI Dysfunction and Chronic Fatigue

16. GI Dysfunction and Liver Detox

a. Any form of GI imbalance will impair hepatic detoxification

b. Dysbiosis, leaky gut, antigen overload, inflammation reaction (increase demands on the liver

c. Pathogenic intestinal bacteria release lipopolysaccharides which goes to the liver and down-regulate the Cytochrome P450 enzymes

d. Beta glucoronidase upregulation ( deconjugation of hormones and chemicals

e. Increase total liver workload

17. GI Laboratory Tests

a. Intestinal permeability test, aka lactulose and mannitol challenge test

b. SIgA Food Sensitivity Test

c. Helicobacter pylori Test

d. Comprehensive Digestive Stool Analysis

e. Oxidative Stress Test

18. Gut Facts

a. GI tract considered another brain- works in conjunction w/cerebral cortex to help maintain homeostasis

b. ~60% of total force of immune system is in gut

i. makes gut most important immune organ

c. Before brain developed - gut was original brain in invertebrate animals

i. The Second Brain, Michael Gershon

d. 95 % of total serotonin production is from GI tract

e. SSRI reduces serotonin to GI tract - can cause nausea, vomiting, constipation.

f. ½ of neurons of PNS are located in digestive tract

g. GI tract has a profound impact on health

i. From healthy gut, we enjoy health, neurologically, psychologically, and immunologically

h. GI tract has as many neural connections as the spinal cord

i. Has more neurons than the rest of the peripheral nervous system

19. Forms the Enteric Nervous System

a. Connected to brain via vagus nerve

b. Can function independently - brain dead patients can continue to digest and absorb intubated feeding indefinitely

c. gut produces all neurotransmitters and hormones that the brain does plus more

d. GI tract is highly susceptible to stress of any kind

i. emotional, physical and toxins

e. There are more than 10000 different kinds of microorganisms in the gut. Half of fecal weight is bacteria.

20. Bacteria Citizens in Our Gut

a. Common Human Intestinal Bacteria & Approximate Concentrations

i. Bacteriodes - ~1010 / gram intestinal contents

ii. Bifidobacteria - ~109 / gram intestinal contents

iii. Eubacteria - ~109 / gram intestinal contents

iv. Streptococci - ~109 / gram intestinal contents

v. Lactobacilli - ~108 / gram intestinal contents

21. GI Blues

a. 2 of top 5 most prescribed drugs in US are for digestive disorders

b. Colorectal cancer is 2nd leading cause of cancer deaths

c. >60 million Americans experience heartburn at least once/month, and about 25 million are daily sufferers

d. 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.

e. IBS alone affects almost 20% of adult population in US

f. 1 million Americans suffer from AIDS

g. 8 million have cancer

h. 12 million battle heart disease.

i. 38 million Americans are victims of digestive disorders

i. Crohn’s, UC, diverticulitis, celiac disease, IBS, constipation, diarrhea, GERD, Candida, food allergies

22. Functions of GI System

a. Reduce complex nutrients into small units for absorption

b. Absorb subunit of nutrients into the blood and lymph

c. Remove toxins and germs that come in through the mouth or excretes via the bile

d. Protein digestion and breaking down large food particles in stomach

e. Carb and lipids digestion in small intestine--duodenum

f. Nutrients absorption in the small intestine--ileum

g. Immunity provided by HCl, SIgA, GALT

h. Nutrients manufactured by friendly flora

i. vitamin K, biotin, short chain FA,

ii. minerals released by fermentation of fibers—large bowel

i. Hormone conversion—rT3 to T3, vitamin D

j. Toxins disposal via bile

23. Digestion and Absorption

a. Protein digestion starts in stomach and requires acid

b. Carb digestion starts in mouth and finishes in small intestine, by pancreatic enzymes

c. Fat and fat soluble vitamins require bile to digest and absorb

i. Bile is produced by the liver, stored in the gall bladder, release during food digestion

ii. Medium and short chain FAs don’t need much bile to digest

24. Second Brain

a. “A hundred million neurotransmitters line the length of the gut, approximately the same number that is found in the brain..."

b. Nearly every chemical that controls the brain in the head has been identified in the gut, including hormones and neurotransmitters.

25. The Brain Gut Connection

26. The Brain Gut Connection

a. Pts with bowel problems tend to have abnormal REM sleep

b. Poor sleep has been reported by many with IBS and non-ulcerative dyspepsia (sour stomach) who complain of awakening tired and unrefreshed in the morning.

c. Abnormal REM sleep is reduced by low-dose treatment with the anti-depressant amitryptiline, which has also been shown to be effective in treating IBS and non-ulcerative dyspepsia.

d. About 25% taking fluoxetine (Prozac) and other types of similar-acting antidepressants experience GI problems - nausea, diarrhea, constipation.

27. Factors Affect GI Health

a. Toxins - petrochemicals, heavy metals, organic compounds, food additives, drugs

b. Trans fatty acids

c. Pathological organisms overgrowth—yeast, fungi, virus, bacteria

d. Extreme Emotions—anger, fear, excitement, anxiety

e. Overeating

f. Malnutrition—protein, fat, vitamin, mineral, essential fatty acids

g. Food or drinks in extreme temperatures

h. Lack of sleep—affect balance of GI flora and hormones

i. Dehydration—GI tract produces more than 4 liters of digestive fluid daily

j. Lack of or excessive dietary fiber

k. Refined sugars in the diet—damage enzymes by glycation

28. Dysbiosis and Asthma

a. Antibiotics weaken natural bacteria in the gut and, stimulate overgrowth of the yeast Candida albicans.

b. Previous studies have shown that overgrowth of yeast adversely affects the body's mucosal immunity.

c. The result: A weakened immune system that becomes vulnerable to allergies and asthma.

29. Allergy and Immune Stress Study - University of Michigan study

a. mice were given antibiotics in drinking water for five days to weaken gut bacteria

b. then injected with candida yeast, to mimic response of antibiotics produce in humans.

c. Finally, mice's nasal passages were exposed to aspergillus

i. mold spore that is a common allergy trigger in humans

d. mice that received antibiotics showed increased sensitivity to mold spore in respiratory systems

i. mice that did not receive antibiotics did not develop sensitivities to mold

e. reaffirms concept of what goes on in gut can play an important role in regulating immune responses--even in 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 body, there is possibility that other chronic diseases have their roots in gut or other parts of body not thought of previously.

30. Leaky Gut and Food Allergies

a. widespread use of antibiotics and dramatic changes in diet in industrialized countries have been accompanied by a striking increase in incidence of allergies and asthma

b. natural flora plays significant role in regulating immune responses

c. When normal flora of GI fall out of balance, body responds in imbalanced ways--symptoms

31. Drugs and Gut

a. 20% of pts with prescription drugs experience side effects

b. most often caused complications - antibiotics, antidepressants, NSAIDs

c. most often reported side effects - GI symptoms, sleep difficulties, fatigue, mood changes

d. SSRI (Prozac, Effexor, Celexa, Zoloft, Paxil) – 3X greater risk of upper GI bleed than those who do not take these drugs

32. Cox2 Inhibitors

a. Anti-inflammatory (pain killers) medications—Vioxx, Celebrex, Bextra

b. Thought to prevent GI bleed - recent data shows they don’t protect GI

c. Increases the incidence of heart attacks

d. Vioxx may have caused anywhere between 400 to 11000 heart attacks in older men according Dr. David Grahm’s report to the FDA panel.

i. voluntarily pulled off 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)

33. Upper GI Tract

34. Disorders of the Upper GI Tract- May interfere with chewing and swallowing

a. Achalasia, AIDS, Alzheimer’s disease, Broken jaw, Cancer, Chemotherapy, Congenital defects, Dental caries, Dry mouth, Gullain-Barre syndrome, Head injury, Ill-fitting dentures, MS, Missing or no teeth, Myasthenia gravis, Oral surgery, Parkinson’s disease, Peridontal disease, Radiation therapy, Temperature sensitivity, Strokes, Surgery, ulceration

35. Disorders of the Stomach

a. GERD (Gastro-esophageal reflux disease), Indigestion, dyspepsia, Gastritis, Hiatal Hernia, Peptic ulcers, Stomach cancer, Nausea, vomiting

36. GERD Prevention

a. Eat small meals and drink liquids an hour before and after meals, avoid stomach distension

b. Relax at mealtime, chew thoroughly, avoid swallowing air

c. Limit foods that relax LES

d. Avoid foods that are acidic, too hot or too cold

e. Maintain healthy weight

f. Avoid tight-fitting clothing

g. Avoid bending down lower than stomach

h. Stop smoking

i. Avoid spicy foods

37. Lower Esophageal Sphincter

a. AKA cardiac sphincter, gastroesophageal sphincter

b. Substances that relax the cardiac sphincter:

i. Alcohol, Anticholinergic agents, Calcium channel blockers, Chocolate, Diazepam, cigarette

38. Myth of Acid Indigestion

a. 95% of people with GERD do not produce enough stomach acids

b. Rotten food in stomach produce organic acids that regurgitate into esophagus ( heartburn

39. Treatment of GERD

a. M/c cause of GERD - insufficient stomach acid production and delayed gastric emptying

b. Betaine HCl

c. Proteolytic enzymes

d. Address ligament laxative problem

e. Address emotional stress

f. Don’t eat large meals when upset

g. Treat hiatal hernia with soft tissue manipulations, diaphragm

h. C3,4,5, mid thoracics, Psoas

40. Conditions Associate with Nausea and Vomitting

a. Pregnancy, GERD, Esophagitis, Peptic ulcer, Gallbladder disorders, Pancreatic disorders, Kidney disorders, Cancer, chemo therapy, Delayed gastric emptying (diabetics), Carbonate beverages

41. Minimize Nausea and Vomitting

a. 1-2 teaspoons of apple cider vinegar

b. Orthophosphoric acid

c. Avoid overeating

d. Use gallbladder support supplements—beet extract, bile salt replacement

e. Ginger tea

f. B6 may be helpful for pregnancy related N/V

42. Hiatal Hernia

a. Another reason for acid reflux

b. Overweight, smoking

c. Certain foods - coffee, chocolate, hot spices, mint can relax the LES allowing acid to get up into the esophagus

43. Gastritis, Peptic and Duodenal Ulcer

a. Delay gastric emptying (gastroparesis)

b. Decreases mucous protection due to complex hormonal changes

c. Increases inflammation

d. Presence of Helicobacter pylori

e. Drugs that blocks acid production may lead to parietal cells atrophy.

44. The 4R Program to Restore GI Health

a. Supplements to “Remove” pathological factors

b. Supplements to “Re-inoculate” Beneficial factors

c. Supplements to “Replace” missing enzymes

d. Supplements to “Repair” damages done to the GI tract

Disorders of the Lower GI Tract

45. Diarrhea, Constipation, Irritable Bowel Syndrome, Gallbladder disorder, Fat malabsorption, Pancreatitis, Cystic Fibrosis, Crohn’s Disease, Dysbiosis, Short-bowel syndrome, Celiac Disease, Diverticulosis, Diverticulitis, IBS, UC, Cancer, Resections of large intestine

46. Inflammation and Gut Health

a. Inflammation is linked to all of the above gut problems

b. Controlling inflammation is paramount in controlling these GI troubles

c. typical American diet is pro-inflammatory

d. Stress-filled lifestyle for all ages

e. Stress cause pro-inflammatory cytokines and chemicals

f. Figure 2-1 - Page 29

47. Effects of Stress on the Body

a. Endocrine system - Adrenalin and other stress hormones are secreted

i. Heart rate speeds up

ii. Muscles tension increases

iii. Breathing rate speeds up

iv. Brain becomes extra alert!!

v. Non-essential systems (immune and digestive) shut down temporarily

vi. Cortisol, causes more sugars to go into the circulation, by converting fat and proteins.

b. Increased risk for heart disease due to continued presence of stress factors

c. Immune system can become depressed increasing risk of diseases, and decreasing body’s resistance

d. Digestive system - cramps, stomach aches, increased risk for ulcers, constipation, diarrhea

e. Mental Health

48. Stress, HPA dysregulation and GI Problems

a. Stress ( sympathetic over-activity ( depressed parasympathetic influence of the GI tract ( multiple GI disorders.

b. Reduced gastric acid production (reduce secretin and CCK( gallbladder suppression ( fat malabsorption ( Gallstone ( fat soluble nutrients deficiency ( depress normal physiology and indigestion.

c. Malnutrition ( lowered immune function ( chronic infection and increase internal stress and maintain vicious cycles of illness

49. IBS

a. poorly understood condition relating to functional abnormality of lower GI

b. 20% of the adults in the US suffered from it

c. 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

d. Diagnosed by ruling out physical causes

e. No known cause, No known cure

i. Meds for symptom relief - antispasmodic, laxative, antidepressants

f. Certain foods can cause symptoms—sub-clinical gluten intolerance

g. Food sensitivity and dysbiosis are considered suspects by many alternative health professionals

h. Stress’ also considered as a major trigger

i. Imbalance of gut hormones especially serotonin may be key to solve mystery

j. Prozac can cause diarrhea and constipation depends on the dose.

k. The drug, Zelnorm acts as a serotonin agonist, stimulates GI tract motion

l. What in nature can cause an imbalance of the serotonin system? Any addictive stuff.

m. Sugar is universal.

50. Effects of Fat Malabsorption

51. Your Gut—The Drug Maker

a. brain contains receptors for benzodiazepine, a drug that relieves anxiety, suggesting that the body produces its own internal source of the drug

b. Pts with liver failure, fell into a deep coma. The coma can be reversed, in minutes, by giving the patient a drug that blocks benzodiazepine.

c. Could depression be caused by a distressed gut releasing too much benzodiazepine?

52. Restore and Maintain Gut Health

a. body is a self-regulating organism

b. There are lots more that our body can do than our conscious mind can ever comprehend

c. Innate intelligence

d. Our ancestors did not have to study what to eat or what medications to use

e. All they had to do was eat whatever mother nature provided for them—they stayed healthy

f. how?

i. Eat wholesome natural, organically grown foods

ii. Avoid all forms of processed foods, refined sugars and carbohydrates

iii. Minimize exposure to toxic chemicals and metals

iv. Get enough sleep, in total darkness

v. Eat enough, but not excessive fiber: vegetables, nuts, seeds, whole grains and fruits

vi. Drink adequate but not excessive clean water, but don’t drink too much water with meals

vii. Chew slowly and thoroughly

viii. Eat until only 80% satisfy

ix. Do not eat while upset, worry or angry

x. Do not eat within three hours of bed time

xi. Do not use drugs unnecessarily

xii. Use probiotics or lacto-fermented foods to replenish friendly flora

xiii. Use coconut oil, raw cream or butter for their antimicrobial short and medium chain fatty acids

xiv. Avoid eating raw foods if any GI ailments present

xv. Eat with relaxing music and with loved ones, in silence

xvi. Use nutritional, herbal and homeopathic supplements

xvii. Exercise regularly, but not after 5 pm

xviii. Avoid foods you are sensitive to

xix. Sleep between 10pm to 6am regularly

The 4R program - protocol to restore digestive health

1. Remove - Remove pathologic microbs

a. Yeast, parasites, bacteria, virus

b. Coconut oil, olive oil have antimicrobial activities

c. Antimicrobial herbs:

i. Zymex (SP) – yeast

ii. Zymex II (SP) – parasites, wormwood, black walnut hull, turmeric, garlic,

iii. Articin (Thorne) – parasites

iv. SF722 (Thorne) – yeast, enzymes, Cat’s claw, Olive leaf extract.

2. Re-Inoculate

a. A good source of beneficial bacteria

b. Lactobacillus, bifidobacterium

c. Lactobacillus sporogenes

d. Hemostatic soil organisms (HSO)

e. Lacto-fermented dairy, vegetables, vinegars, Kombucha

f. Lactic acid yeast

3. Replace - To aide digestion while repairing the GI tract, support digestive enzymes activities and gallbladder function.

a. HCl

b. Bile salt

c. Beet leaves extract

d. Plant enzymes—bromelain, papaya enzyme

e. Proteolytic enzymes

4. Repair

a. Herbs or nutrients that speed the healing of damaged gut mucosa

b. Slippery Elm bark, Aloe vera, Clostrum, Coconut oil, N-acetyl-cysteine, L-glutamine, Quercitin, Antioxidant, vitamins (A, C, E), MVM

Nutritional Supplements

1. Digestive enzymes, Hydrochloric acid, Apple cider vinegar, Vitamin A , Vitamin B, Vitamin C, Vitamin D, Vitamin E, B12, B6, riboflavin, Calcium, Magnesium, Zinc, Selenium, Bile salt, Dietary fibers, Omega 3 fatty acid, Short and medium chain fatty acids—raw butter and coconut oil

Herbal Remedies

1. Ginger, Pepper Mint, Apple cider vinegar, Garlic, Slippery Elm Bark, Boswellia, Pau d’Arco, Cat’s Claw, Echinacea

Clear digestive problems first

1. Patients with marked GI symptoms

2. Lab test: stool analysis, food intolerance

3. Dietary recommendations

4. Supplements

a. ANTIMICROBIAL HERBS

b. DIGESTIVE ENZYMES, HCL

c. PROBIOTICS

d. NUTRIENTS THAT PROTECT AND HEAL MUCOUS MEMBRANE

e. Caution

i. Do not recommend a liver detox for pts with severe GI prob

ii. Pts must have normal bowel movements before engaging any detox program

5. Emotional Stress Relief

a. Techniques for emotional problems—NET, EFT

b. Time management

c. Get together with friends

d. Practice forgiveness

e. Volunteering and reach out to others

f. Exercise—yoga, taichi, breathing exercise

g. Hobbies

Hair Mineral Analysis

1. Trace elements (minerals) "are the spark-plugs in the chemistry of life". They are the more important factors in human nutrition than are vitamins. The body can manufacture many vitamins, but it cannot produce necessary trace minerals.

2. can provide information about energy level, immune system, carb tolerance, emotional balance, and glandular activity

3. can help reduce guesswork in recommending diets and nutritional supplements

4. can be used to monitor metabolic changes as a result of any form of therapy

5. Hair

a. 2nd most metabolically active tissue in body

i. affected by blood, perspiration, environment, genetics, hormones, enzymes

b. Represents what is occurring inside cells and submolecular figures of body

i. Blood test shows what is happening outside the cell and the waste material being discarded

c. Gives a reading of what is being stored in body

6. Hair Tissue Mineral Analysis

a. Considered a standard test used around the world for biological monitoring of trace elements and toxic metals in humans and animals

b. Same technology is used for soil testing and testing of rock samples to detect mineral levels

c. Hair, like all body tissues, contains minerals deposited as the hair grows

d. Although hair is dead, minerals remain as hair continues to grow out

e. Hair sample cut close to scalp provides information about mineral activity in the hair that took place over past three to four months, depending on rate of hair growth

f. Minerals are locked inside dead hair cell

i. leaving a clear record of the hair metabolism

g. Mineral imbalances show up much sooner in hair than in blood

h. Minerals are pulled out of tissues to maintain blood levels

i. Serum mineral levels often appear normal even if one is ill.

j. Hair tissue reflects body mineral and trace element stores more accurately for many elements than blood or urine

7. Hair Vs. Blood and Urine

a. Hair - grows slowly, very stable protein, tends to accumulate minerals

i. average level of elements over a period of time may be accurately determined

b. Blood - shows only what is present at moment it is drawn

i. levels of many substances depend on level of hydration, composition of recent meals, activity level, and time of day

c. Urine - what is excreted from the body by the kidneys

8. Reasons to Use The Hair Mineral Analysis Testing

a. Screen of information that directly relates to cellular activity

b. Trends of disease or disorder can be identified before they occur and to be able to take action before they surface

c. Assess efficiency of body’s energy systems

d. Determine Oxidation Type

e. Detect Toxic Metals

f. Biochemical imbalances can contribute to many mental and emotional disturbances

g. The level and ratio of the tissue minerals in body relate to activity of specific glands and organs

h. Determine levels of nutrition support to correct imbalance and monitor progress

i. Non-invasive and inexpensive

9. Validation of Hair Analysis

a. Over 1,500 scientific articles in world medical literature attest to reliability and effectiveness of hair analysis as a means of evaluating tissue mineral levels

b. Value of hair analysis was even upheld in a Federal Court in Alexandria, Virginia (Civil Action No. 84-803-A).

c. Acting on a complaint from FTC against a hair analysis laboratory charged with engaging in deceptive acts or practices.

d. Judge held that defendants presented substantial evidence that there is a body of authoritative medical literature supporting the view that hair analysis is useful in determining the element whole body content.

e. Dr. William H. Strain (1982), of the Case Western Reserve University School of Medicine in Cleveland, Ohio, reported that up to 60 elements may be readily determined in hair by atomic absorption spectroscopy, or by a more elaborate technique known as ICP arc spectroscopy.

f. He stated that Hair analysis offers potential for the study and control of the aging process.

g. Scientists have found correlation in levels of various minerals with aging (Eltayeb, and Van Grieken, 1990; Gordon, 1985; Meng, 1998; Smith; Thimaya, 1982; and Zakrgynska-Fontaine, 1998) and with a number of diseases, including diabetes (Kieselstein, 1984), learning disorders (Rimland and Larson, 1983), and cardiovascular conditions (Smith, 1987; Huang, et al, 1991).

h. Many trace element deficiencies develop with aging, and that many of these deficiencies may be corrected by dietary modifications and supplementation

10. Summary

a. Mineral levels in hair correspond to levels of minerals in body

b. Minerals are essential for normal healthy functioning of all living cells

c. Environmental factors contribute to mineral imbalances because of toxic mineral exposure

d. Improper dietary habits can also lead to mineral imbalances

e. Hair analysis can ascertain imbalances and manage progress of nutritional support

11. How To Order a Hair Analysis

a. Call ARL to establish an account

b. Kits are free of charge

c. Health professionals and students (provide student ID) can receive an analysis for free

d. Profiles #2 and #4 are commonly ordered

e. Profile #2 is needed for first test, doctor’s cost is $52

f. Profile #4 is for any subsequent test, cost is $49

g. Repeat test after 3 months

i. 2225 W. Alice Avenue, Phoenix, Arizona  85021 USA  

ii. 1-800-528-4067

iii.

12. How to Collect Sample

a. work in clean environment

b. No Permanent, bleached nor coloring in the last 4 weeks

i. Wash hair at least 10-12 times if chemically treated

c. Free of all gels, oils and hair creams

d. Do not use water soften water to wash hair

e. Note if use dandruff shampoo, brand names

f. Scalp hair is the only source recommended for analysis. Pubic and other body hair should only be used as a last resort if scalp hair is not available

g. Contaminants

i. Daily swimming in pools can raise sodium and copper levels

ii. Heavy sweating immediately before cutting sample can raise sodium and potassium readings

iii. ‘Grecian Formula’ and ‘Youth Hair’ hair dye contain lead and iron

iv. Head & Shoulders shampoo can elevate the zinc level

v. Selsun Blue shampoo can elevate the selenium level

vi. Bleaching and permanents can affect hair readings

h. Small portions from at least four to five different locations of scalp

i. High grade stainless steel scissors or thinning shears should be used to cut the hair as close to the scalp as possible

j. Collect about a tablespoon of hair using a paper scale provided in test kit

k. Do not use plastic bags in place of standard paper envelopes to hold hair specimen.

l. Do not use staples, paper clips, adhesive tape, aluminum foil or other metal and paper material of any kind to seal, secure or wrap the hair envelope and/or the hair specimen contained within.

m. Mail sample to the lab

13. Lab Analysis

a. Laboratory technicians cut the sample into small pieces and dissolve it in acid overnight. A carefully measured amount is then burned in a computer-controlled spectrometer.

b. Each mineral gives off characteristic colors or spectra, which are read by sensitive detectors.

c. The test provides a reading of the minerals deposited in the cells and interstitial spaces of the hair over a 2-3 month period.

d. It does not provide an assessment of the mineral content of other tissues of the body.

e. Testing the hair can allow one to infer what is occurring in other tissues of the body.

f. 21 mineral levels are tested in each hair sample:

Nutrient Minerals: Calcium, Iron, Molybdenum, Selenium, Chromium, Lithium, Nickel, Sodium, Cobalt, Magnesium, Phosphorus, Vanadium, Copper, Manganese, Potassium, and Zinc.

g. Toxic Minerals: Aluminum, Arsenic, Cadmium, Lead, and Mercury.

14. The Report – it is all a matter of ratios

15. Minerals Ratios - functional data can be derived about organ and gland, mental and emotional tendencies, body’s response to stress and how to support the body with nutrition and diets.  

a. Many disease 'trends' can also be identified

16. Mineral Patterns and Metabolism

a. normal metabolism of hair tissue

b. accumulation of mineral in soft tissue, called bio-unavailability

c. excretion of mineral due to any number of causes

d. displacement (a high reading) due to a toxic metal which displaces a physiological mineral.

e. loss through the hair due to inability to retain a mineral

f. low reading due to retention of that mineral elsewhere in the body.

g. 'defender' is a low or high reading that occurs to compensate or maintain another more critical mineral level or ratio

17. Hair Minerals and Metabolism

a. Ca and Magnesium: high = slow oxidizer

b. Na and Potassium: high = fast oxidizer

c. Ca and Na: high = mixed oxidizer

d. Depends on the levels of these minerals, there are mild, intermediate and advanced forms of energy metabolism

18. Mineral Pattern and Stress

a. Mineral pattern can be correlated with Stages of Stress described by Selye

i. Toxic metal levels are higher in alarm stage - metabolism tends to be faster and toxic metals are eliminated more rapidly

ii. Zinc and copper tend to be lower in alarm stage

iii. Iron and manganese levels are lower in exhaustion stage

b. Mineral Patterns and Endocrine Functions

i. Ca/Mg (6.67:1) indicates pancreas function

ii. Ca/K (4:1) indicates thyroid function

iii. Na/Mg (4.17:1) indicates glucocorticoid function

iv. Na/K (2.50:1) indicates mineral corticoid function

v. Ca/P (2.5:1) indicates protein utilization and absorption balance

vi. Zn/Cu (8:1) indicates sexual hormones balance

19. Toxic Metals – Aluminum, Arsenic, Cadmium, Copper, Lead, Manganese , Mercury

20. Hair Analysis Worksheet

a. Ratio > 13 = May be overeating carbs, emotional defensiveness/conflict, defending a lifestyle imbalance that is not in their best interest, cognitive dissonance

b. 13 – 18 = Moderate, > 18 = Extreme

c. Ratio 10 – 13 = Overeating carbs, tendency towards Insulin Resistance

d. High Ca = Protection, defended, defensive, lowered cell permeability, calcium shell Ca > 150 = Mild, >200=Moderate, >250 Extreme

e. Ideal ratio = 6.67, Good range = 3.3 - 10

f. Ratio < 3.3 = Magnesium loss, may also have blood sugar issues, hidden Na/K inversion 2.5 – 3.3 = Moderate, < 2.5 = Extreme

21. Ca/K Thyroid {Defines Oxidation Rate}

a. High ratio = Decreased thyroid effect (at the cellular level), 8 - 50 = Moderate, > 50 = Extreme

b. High Ca = Protection, defended, defensive, lowered cell permeability, calcium shell Ca > 150 = Mild, >200=Moderate, >250 Extreme

c. Low K (50

d. Ideal ratio = 4, Good range = 3 - 8

e. Low ratio = Increased thyroid effect (at the cellular level) and/or toxicity 1 - 3 = Moderate, 20 = Extreme

c. Ideal ratio = 4.17, Good range = 3 - 6

d. Low ratio = decreased adrenal effect, chronic stress, exhaustion reaction

e. 1- 2.5 = Moderate, 12 = Extreme

c. Ideal ratio = 2.5, Good range = 2.3 - 5

d. Low ratio (inversion) = decreased adrenal effect (exhaustion), chronic stress, lowered energy & energy reserves, decreased immunity, protein catabolism, poor digestion, allergic tendencies, carbohydrate intolerance, diabetic tendency, liver & kidney stress, cardiovascular stress, tendency toward degenerative disease, frustration, resentment, hostility

24. Na/K

a. 2 – 2.3 = Moderate, 1 – 2 = Severe

b. 15 = Extreme

b. Female or male hormone imbalance, cardiovascular stress, tendency toward atherosclerosis, Zn loss, look for hidden Cu.* (See below)

c. Ideal ratio = 8, Good range = 6.5 - 10

d. Low ratio = below 6.5 - Cu toxicity (see for in-depth info. on Cu toxicity) Estrogen Dominance, female or male hormone imbalance, emotional problems, PMS, volatile, depressed, detached, cardiovascular stress, tendency to bruise, tendency for blood vessel weakening 3 – 6.5 = Moderate, < 3 = Extreme

e. Zn roughly correlates with progesterone effect in women, testosterone effect in men.

f. Cu roughly correlates with estrogen effect in both sexes.

g. *Hidden Cu Toxicity in slow oxidizers occurs when ANY of the following are present: Cu 50, Hg >.06, Na/K ratio < 2.5, K < 4 Fast oxidizers usually have a true low Cu & Zn.

h. NOTE: With hidden Cu, the symptoms of a low Zn/Cu ratio will be present.

26. Ca/P - Sympathetic/Parasympathetic and Protein Usage

a. High ratio = > 2.7 - parasympathetic state, 2.7 – 8 = Moderate, > 8 = Extreme

b. Ideal ratio = 2.5

c. Good range = 2.3 – 2.7

d. Low ratio = < 2.3 - sympathetic state, 1.5 – 2.3 = Moderate, < 1.5 = Extreme

e. PROTEIN USAGE PHOSPHORUS (P) LEVELS INDICATE PROTEIN USAGE, PROTEIN RESERVES, & TISSUE BREAKDOWN. WHEN P IS HIGH OR LOW ASK THE FOLLOWING QUESTIONS:

f. Eating enough protein?

g. Good protein sources?

h. Digesting protein (HCl)?

i. Low P = protein deficiency, excessive tissue breakdown, impaired digestion, poor source of protein, (low P is worse than high), impaired protein synthesis (tends to be worse with low Zn)

j. High P = pubic hair sample or excessive tissue breakdown, impaired digestion

Introduction to Salivary Hormone Profiles

1. allows quick, easy, inexpensive and relatively accurate information to aide physician in diagnosing hormone related and other conditions

2. Continual monitoring

3. Must not be used as the sole means of evaluating the patient, but in conjunction with a history, physical exam and other lab tests as indicated

4. Advantages of Test Saliva

a. Non-invasive

b. No special equipment needed

c. Samples collection is not as complicated

d. Non-traumatic—better compliance

e. Conducive to frequent tests

f. Cost effective for screening large population

5. Saliva Sampling

a. Gland-specific saliva

i. Collected directly from individual salivary glands

ii. Gland specific pathology

b. Whole saliva

i. Most frequently studied

ii. Used for evaluating systemic disorders

iii. Mixture of oral fluids

6. Whole Saliva

a. Secretions from major and minor salivary glands

b. Gingival crevicular fluid

c. Expectorated bronchial and nasal secretion

d. Serum and blood derivatives from oral wounds, bacteria, virus and fungi

e. Desquamated epithelial cells

f. Other cellular components

g. Food debris

7. Diseases and Conditions which Can Be Diagnosed by Saliva tests

a. Cystic fibrosis, Celiac disease, Sjogren’s Syndrome, Cancer, Viral diseases, Drug usage, Hormones levels

8. Accuracy of Salivary Hormone Testing

a. Best for steroidal hormones—free hormones

i. Sex hormones, cortisol, DHEA

ii. rate of diffusion of steroid hormones, particularly cortisol is usually high enough to maintain a constant relationship between salivary and serum levels of the hormone regardless of salivary flow rate

b. Protein hormones is not as clear

9. How to Incorporate Salivary Tests Into the Practice

a. Call a lab that offer saliva tests

b. Set up an account

c. Test kits are generally free of charge

d. Most labs require payment upfront when specimens are submitted for testing

e. Cost varied with different profiles, general between $50-200.

f. You can set up the account that you pay the lab or have your patient pay directly to the labs, send along with their specimen

g. Results are mailed or faxed to referring dr

10. Commonly Used Tests

a. Adrenal Stress Index (ASI)

b. Expanded Female Hormone Profile (eFHP)

c. Female Hormone Panels (FHP)

d. Expanded Postmenopausal Hormone Panel (ePHP)

e. Postmenopausal Hormone Panel (PHP1, PHP2)

f. Expanded Male Hormone Profile (eMHP)

g. Male Hormone Profile (MHP)

h. Salivary Thyroid Panel (STP)

i. Four Foods Test

j. GI Health Panels

11. Specimen Collection

a. Before collecting saliva, rinse mouth with cold water, chew gum to stimulate saliva production is fine

b. Take vile provided by lab and fill it halfway with saliva (approx. 3-4cc)

c. Label vile with name, time and date

d. Do not cough and fill vile with throat mucous

e. Put all samples into mailing envelop along with payment, requisition form, name of referring dr.

f. Mail to lab immediately after all specimens have been collected, preferably in the beginning part of the week.

g. Smoking, coffee, exogenous hormones and certain drugs will significantly alter lab findings

12. Adrenal Stress Index

a. Circadian rhythm of cortisol in a single day

b. Morning, noon, afternoon, bedtime

i. Cortisol

ii. DHEA

iii. SIgA

iv. SIgA gliadin

v. Insulin

13. Order ASI When…

a. Patient with significant adrenal symptoms marked in SSF

b. GI and liver/gallbladder symptoms

c. Osteoporosis, Chronic fatigue, Chronic infections, Fibromyalgia, Insomnia

14. Expanded Pre-menopausal Female Hormone Profile

a. Cycling females

b. Collection throughout the menstrual cycle

c. Progesterone, estradiol, estrone, estriol, DHEA, testosterone, LH and FSH

d. Comprehensive interpretation report listing the follicular and luteal phases’ hormone output

e. Pre-menopausal women with hormonal irregularities

f. Patient must not be taking exogenous hormones

15. Pre-menopausal Female Hormone Profile

a. All except LH and FSH as in eFHP

b. Evaluate follicular and luteal hormones output

c. Female patient with hormonal irregularity

d. For patients who are on exogenous hormones

e. Use to monitor effect of HRT

16. Order FHP When…

a. Pre-menopausal women with many female only symptoms marked in SSF

b. Menstrual problems

c. Infertility

d. Adrenal and thyroid disorders refractive to adrenal and thyroid supports

17. Expanded Postmenopausal Hormone Profiles - ePHP

a. Determine the pituitary-ovarian axis for patient not on exogenous hormone augmentation

b. Provides a breast and uterus proliferative potential index

i. One random sample

ii. Baseline levels of estradiol, estrone, estriol, DHEA, Testosterone, Progesterone, LH, FSH

18. Postmenopausal hormone panels

a. PHP1 (short)

i. Similar to ePHP, except LH and FSH are not measured

ii. One random sample

iii. Determine hormone levels for augmentation therapy

b. PHP2 (Long)/Perimenpausal

i. Two samples: baseline and post hormone challenge, 6-7—14 days apart

ii. Determine dosage and effects of HRT or other hormone modulating protocol

iii. Determine if a woman is menopausal if the two profiles are very similar, not if they are very different.

19. Order PHP When…

a. Post menopausal female patients with female only symptoms heavily marked in SSF

b. Assessing menopausal status

c. Monitoring hormonal balancing protocols or HRT

20. Expanded Male Hormone Profile

a. One random sample

b. Measures: Testosterone, DHT, DHEA, progesterone, estrone, FSH, LH

c. Evaluate the pituitary-gonadal axis

d. Standard baseline in male patients

e. Used to determine the need for hormone augmentation therapy

21. Male Hormone Profile

a. Similar to eMHP except FSH and LH are not included

b. Monitoring hormone levels in patients on exogenous hormone augmentation therapy

c. Note Testosterone to Estrogen ratio, normal is 50:1

d. Normal T level but with low T/E ratio is estrogen dominance, a relative low T state

22. Order MFP When…

i. Male only symptoms heavily marked in SSF

ii. Chronic fatigue, fibromyalgia

iii. Osteoporosis

iv. GI/liver/gallbladder, adrenal and/thyroid problems refractive to nutritional support for those areas

v. Andropause

23. Salivary Thyroid Panel

a. Evaluate free fraction of T3, T4, TSH and thyroid microsomal antibody

b. Identify functional problems of pituitary-thyroid axis

c. Screen for possible autoimmune thyroid conditions

24. Order STP When…

a. Patients with heavily marked hyper or hypothyroid symptoms marked in SSF

b. Depression

c. Osteoporosis

d. Adrenal fatigue refractive to adrenal support

e. CF/FMS

f. Weight problems

g. ADD/ADHD

h. Liver/Gallbladder/GI problems

25. Four Foods Test

a. Major food intolerances

b. SIgA for corn, soy, gluten and casein

c. Indicated for patients with significant adrenal dysfunctions

26. GI Health Panels

a. 15 or 22 conjoint parameter analysis

b. Intended to evaluate gastrointestinal function and health non-invasively.

c. The panel employs three stool and two saliva specimens.

27. Need for GI Health Panels

a. Inflammatory bowel disease

b. Chronic loose stool or constipation

c. Fat, grain, and food intolerance

d. School & pool associated GI problems

e. Chronic abdominal discomfort/pain

f. Chronic fatigue and fibromyalgia

g. Excessive eating pattern/Anorexia

h. Post travel loose stool/diarrhea

i. Sudden changes in bowel habits

j. Bloating, maldigestion, heartburn

k. Excess gas and flatulence

l. Chronic skin conditions

m. Hyperactivity

n. Poor sleeping habits

28. The Liver Detox Deficiency Connection

a. Patients with increased levels of hormones, estrogen dominance, adrenal hyperactivity or hypoadrenia, have them do a Detox Questionnaire

b. Liver detox is almost always a problem in patients with hormone overload

c. If liver toxicity is not corrected, HRT will eventually make patient feel worse

29. Prioritization

a. Adrenal and blood sugar disorders

b. GI problems and food sensitivities

c. Liver detoxification

d. Essential fatty acid imbalance

e. Micronutrient deficiencies

30. Summary

a. Salivary hormone testing is an effective and inexpensive method to assess patient

b. Always use these tests in conjunction with other diagnosing modalities

Bolded topics in syllabus between weeks: 9-11

Female Complaints

Cervical Dysplasia pp. 109-113

Fibrocystic Breast Disease pp. 181-184

Menopause pp. 319-326

Menorrhagia pp. 327-331

Nausea and Vomiting of pregnancy pp. 352-354

Pelvic Inflammatory Disease pp. 383-391

Premenstrual Syndrome pp. 411-422

Vaginitis and Vulvovaginitis pp. 472-483

Hormanal balancing with nutriton

Male Complaints

Benign prostatic hyperplasia pp. 90-94

Epididymitis 164-168

Male Infertility pp. 310-318

Week 10:

Metabolic Disorders

Alcoholism pp. 20-27

Gout pp. 202-207

Obesity pp. 355-363

Systemic Syndromes

Chronic Fatigue Syndrome pp. 125-130

Fibromyalgia

Chronic Candidasis pp. 120-124

HIV/AIDS pp. 224-236

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