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.
  3. These approaches do not seek to uncover the underlying causes or triggers.
  4. Suppressing symptoms rather than improving functions of the GI tract often lead to further deterioration.
  5. Close interrelationship the GI tract plays with every major system in the body
  6. GI-Immune, Pain, Inflammation
  7. Over 60% of human immune system is in the GI tract
  8. 99% of the body’s neurotransmitters
  9. Any adverse antigen that interacts with gut-associated lymphoid tissue (GALT) will trigger inflammatory response
  10. Lead to production of inflammatory mediators causing pain, inflammation and vasoconstriction
  11. GI dysfunction is commonly found in patients with any chronic pain.
  12. 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
  1. Functional Hypothyroidism and the GI Tract Dysbiosis
  2. 20% of active T3 is dependent upon a healthy gut microflora
  3. Imbalance gut flora can cause decreased T3
  4. Gut dysbiosis put stress on the adrenal glands  cortisol
  5. Cortisol can shift T4 into higher % of inactiveT3 rather than active T3
  6. GI Dysfunction and Autoimmune Disorders
  7. GI Disorders and Adrenal Stress
  8. HPA axis involvement when GALT is activated
  9. Adrenal alarm response
  10. Decrease DHEA  reduce other steroid hormone production
  11. Potential shift away from anabolic to catabolic state
  12. Sub-clinical GI sensitivities to food antigen are major cause of adrenal stress and often undetected, unsuspected
  13. Elevated cortisol suppress GI mucosa regeneration, decreasesIgA  increases dysbiosis
  14. GI Dysfunction and Adrenal Stress
  15. GI Dysfunction and Estrogen Dominance
  16. Dysbiosis increase Beta Glucoronidase activity
  17. Uncoupling conjugated estrogen
  18. Reactivate estrogen and increase total estrogen load and liver stress
  19. Ratio of 2-OH and 16-OH estrogen imbalance toward increase risks of reproductive organs cancers
  20. GI Dysfunction and B-12 Deficiency
  21. Megaloblastic anemia
  22. B12 absorption is dependent on HCl in stomach, pancreatic enzymes and healthy brush border
  23. Increase serum homocysteine , an inflammatory marker
  24. Emotional and psychological signs and symptoms
  25. GI Dysfunction on Moods and Depression
  26. Decreases neurotransmitters synthesis and glucose absorption
  27. enteric system produces 99% of serotonin (5HT)
  28. Abnormal glucose absorption may cause glycemic dysregulation and impact mood, behavior and emotion controls
  29. GI Dysfunction and Weight Control
  30. can disrupt intercellular communication and make weight loss difficult
  31. cytokines can prevent lipolysis and increase lypogenesis
  32. Leaky Gut and Food Sensitivities
  33. Healthy GI tract has tight junctions between enterocytes to prevent absorption of large food molecules.
  34. During chronic inflammation or stress, tight junctions may be breached allowing large food molecule to enter bloodstream
  35. Triggering histamine, leukotrienes, postanoids and PGs leading to food allergies.
  36. GI Dysfunction and CVD
  37. GI Dysfunction and Neurodegenerative Disorders
  38. GI Dysfunction and Chronic Fatigue
  39. GI Dysfunction and Liver Detox
  40. Any form of GI imbalance will impair hepatic detoxification
  41. Dysbiosis, leaky gut, antigen overload, inflammation reaction increase demands on the liver
  42. Pathogenic intestinal bacteria release lipopolysaccharides which goes to the liver and down-regulate the Cytochrome P450 enzymes
  43. Beta glucoronidase upregulation  deconjugation of hormones and chemicals
  44. Increase total liver workload
  45. GI Laboratory Tests
  46. Intestinal permeability test, aka lactulose and mannitol challenge test
  47. SIgA Food Sensitivity Test
  48. Helicobacter pylori Test
  49. Comprehensive Digestive Stool Analysis
  50. Oxidative Stress Test
  51. Gut Facts
  52. GI tract considered another brain- works in conjunction w/cerebral cortex to help maintain homeostasis
  53. ~60% of total force of immune system is in gut
  54. makes gut most important immune organ
  55. Before brain developed - gut was original brain in invertebrate animals
  56. The Second Brain, Michael Gershon
  57. 95 % of total serotonin production is from GI tract
  58. SSRI reduces serotonin to GI tract - can cause nausea, vomiting, constipation.
  59. ½ of neurons of PNS are located in digestive tract
  60. GI tract has a profound impact on health
  61. From healthy gut, we enjoy health, neurologically, psychologically, and immunologically
  62. GI tract has as many neural connections as the spinal cord
  63. Has more neurons than the rest of the peripheral nervous system
  64. Forms the Enteric Nervous System
  65. Connected to brain via vagus nerve
  66. Can function independently - brain dead patients can continue to digest and absorb intubated feeding indefinitely
  67. gut produces all neurotransmitters and hormones that the brain does plus more
  68. GI tract is highly susceptible to stress of any kind
  69. emotional, physical and toxins
  70. There are more than 10000 different kinds of microorganisms in the gut. Half of fecal weight is bacteria.
  71. Bacteria Citizens in Our Gut

  1. Common Human Intestinal Bacteria &Approximate Concentrations
  2. Bacteriodes - ~1010 / gram intestinal contents
  3. Bifidobacteria - ~109 / gram intestinal contents
  4. Eubacteria - ~109 / gram intestinal contents
  5. Streptococci - ~109 / gram intestinal contents
  6. Lactobacilli - ~108 / gram intestinal contents
  1. GI Blues
  2. 2 of top 5 most prescribed drugs in US are for digestive disorders
  3. Colorectal cancer is 2ndleading cause of cancer deaths
  4. 60 million Americans experience heartburn at least once/month, and about 25 million are daily sufferers
  5. 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.
  6. IBS alone affects almost 20% of adult population in US
  7. 1 million Americans suffer from AIDS
  8. 8 million have cancer
  9. 12 million battle heart disease.
  10. 38 million Americans are victims of digestive disorders
  11. Crohn’s, UC, diverticulitis, celiac disease, IBS, constipation, diarrhea, GERD, Candida, food allergies
  12. Functions of GI System
  13. Reduce complex nutrients into small units for absorption
  14. Absorb subunit of nutrients into the blood and lymph
  15. Remove toxins and germs that come in through the mouth or excretes via the bile
  1. Protein digestion and breaking down large food particles in stomach
  2. Carb and lipids digestion in small intestine--duodenum
  3. Nutrients absorption in the small intestine--ileum
  4. Immunity provided by HCl, SIgA, GALT
  5. Nutrients manufactured by friendly flora
  6. vitamin K, biotin, short chain FA,
  7. minerals released by fermentation of fibers—large bowel
  8. Hormone conversion—rT3 to T3, vitamin D
  9. Toxins disposal via bile
  1. Digestion and Absorption
  2. Protein digestion starts in stomach and requires acid
  3. Carb digestion starts in mouth and finishes in small intestine, by pancreatic enzymes
  4. Fat and fat soluble vitamins require bile to digest and absorb
  5. Bile is produced by the liver, stored in the gall bladder, release during food digestion
  6. Medium and short chain FAs don’t need much bile to digest
  7. Second Brain
  8. “A hundred million neurotransmitters line the length of the gut, approximately the same number that is found in the brain..."
  9. Nearly every chemical that controls the brain in the head has been identified in the gut, including hormones and neurotransmitters.
  10. The Brain Gut Connection
  11. The Brain Gut Connection
  12. Pts with bowel problems tend to have abnormal REM sleep
  13. 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.
  14. 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.
  15. About 25% taking fluoxetine (Prozac) and other types of similar-acting antidepressants experience GI problems - nausea, diarrhea, constipation.
  16. Factors Affect GI Health
  17. Toxins - petrochemicals, heavy metals, organic compounds, food additives, drugs
  18. Trans fatty acids
  19. Pathological organisms overgrowth—yeast, fungi, virus, bacteria
  20. Extreme Emotions—anger, fear, excitement, anxiety
  21. Overeating
  22. Malnutrition—protein, fat, vitamin, mineral, essential fatty acids
  23. Food or drinks in extreme temperatures
  24. Lack of sleep—affect balance of GI flora and hormones
  25. Dehydration—GI tract produces more than 4 liters of digestive fluid daily
  26. Lack of or excessive dietary fiber
  27. Refined sugars in the diet—damage enzymes by glycation
  28. Dysbiosis and Asthma
  29. Antibiotics weaken natural bacteria in the gut and, stimulate overgrowth of the yeast Candida albicans.
  30. Previous studies have shown that overgrowth of yeast adversely affects the body's mucosal immunity.
  31. The result: A weakened immune system that becomes vulnerable to allergies and asthma.
  32. Allergy and Immune Stress Study - University of Michigan study
  33. mice were given antibiotics in drinking water for five days to weaken gut bacteria
  34. then injected with candida yeast, to mimic response of antibiotics produce in humans.
  35. Finally, mice's nasal passages were exposed to aspergillus
  36. mold spore that is a common allergy trigger in humans
  37. mice that received antibiotics showed increased sensitivity to mold spore in respiratory systems
  38. mice that did not receive antibiotics did not develop sensitivities to mold
  39. 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.
  40. Leaky Gut and Food Allergies
  41. 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
  42. natural flora plays significant role in regulating immune responses
  43. When normal flora of GI fall out of balance, body responds in imbalanced ways--symptoms
  44. Drugs and Gut
  45. 20% of pts with prescription drugs experience side effects
  46. most often caused complications - antibiotics, antidepressants, NSAIDs
  47. most often reported side effects - GI symptoms, sleep difficulties, fatigue, mood changes
  48. SSRI (Prozac, Effexor, Celexa, Zoloft, Paxil) – 3X greater risk of upper GI bleed than those who do not take these drugs
  49. Cox2 Inhibitors
  50. Anti-inflammatory (pain killers) medications—Vioxx, Celebrex, Bextra
  51. Thought to prevent GI bleed - recent data shows they don’t protect GI
  52. Increases the incidence of heart attacks
  53. Vioxx may have caused anywhere between 400 to 11000 heart attacks in older men according Dr. David Grahm’s report to the FDA panel.
  54. 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)
  55. Upper GI Tract
  56. Disorders of the Upper GI Tract- May interfere with chewing and swallowing
  57. 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
  58. Disorders of the Stomach
  59. GERD (Gastro-esophageal reflux disease), Indigestion, dyspepsia, Gastritis, Hiatal Hernia, Peptic ulcers, Stomach cancer, Nausea, vomiting
  60. GERD Prevention
  61. Eat small meals and drink liquids an hour before and after meals, avoid stomach distension
  62. Relax at mealtime, chew thoroughly, avoid swallowing air
  63. Limit foods that relax LES
  64. Avoid foods that are acidic, too hot or too cold
  65. Maintain healthy weight
  66. Avoid tight-fitting clothing
  67. Avoid bending down lower than stomach
  68. Stop smoking
  69. Avoid spicy foods
  70. Lower Esophageal Sphincter
  71. AKA cardiac sphincter, gastroesophageal sphincter
  72. Substances that relax the cardiac sphincter:
  73. Alcohol, Anticholinergic agents, Calcium channel blockers, Chocolate, Diazepam, cigarette
  74. Myth of Acid Indigestion
  75. 95% of people with GERD do not produce enough stomach acids
  76. Rotten food in stomach produce organic acids that regurgitate into esophagusheartburn
  77. Treatment of GERD
  78. M/c cause of GERD - insufficient stomach acid production and delayed gastric emptying
  79. Betaine HCl
  80. Proteolytic enzymes
  81. Address ligament laxative problem
  82. Address emotional stress
  83. Don’t eat large meals when upset
  84. Treat hiatal hernia with soft tissue manipulations, diaphragm
  85. C3,4,5, mid thoracics, Psoas
  86. Conditions Associate with Nausea and Vomitting
  87. Pregnancy, GERD, Esophagitis, Peptic ulcer, Gallbladder disorders, Pancreatic disorders, Kidney disorders, Cancer, chemo therapy, Delayed gastric emptying (diabetics), Carbonate beverages
  88. Minimize Nausea and Vomitting
  89. 1-2 teaspoons of apple cider vinegar
  90. Orthophosphoric acid
  91. Avoid overeating
  92. Use gallbladder support supplements—beet extract, bile salt replacement
  93. Ginger tea
  94. B6 may be helpful for pregnancy related N/V
  95. Hiatal Hernia
  96. Another reason for acid reflux
  97. Overweight, smoking
  98. Certain foods - coffee, chocolate, hot spices, mint can relax the LES allowing acid to get up into the esophagus
  99. Gastritis, Peptic and Duodenal Ulcer
  100. Delay gastric emptying (gastroparesis)
  101. Decreases mucous protection due to complex hormonal changes
  102. Increases inflammation
  103. Presence of Helicobacter pylori
  104. Drugs that blocks acid production may lead to parietal cells atrophy.
  105. The 4R Program to Restore GI Health
  106. Supplements to “Remove” pathological factors
  107. Supplements to “Re-inoculate” Beneficial factors
  108. Supplements to “Replace” missing enzymes
  109. Supplements to “Repair” damages done to the GI tract

Disorders of the Lower GI Tract

  1. 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
  2. Inflammation and Gut Health
  3. Inflammation is linked to all of the above gut problems
  4. Controlling inflammation is paramount in controlling these GI troubles
  5. typical American diet is pro-inflammatory
  6. Stress-filled lifestyle for all ages
  7. Stress cause pro-inflammatory cytokines and chemicals
  8. Figure 2-1 - Page 29
  9. Effects of Stress on the Body
  10. Endocrine system - Adrenalin and other stress hormones are secreted
  11. Heart rate speeds up
  12. Muscles tension increases
  13. Breathing rate speeds up
  14. Brain becomes extra alert!!
  15. Non-essential systems (immune and digestive) shut down temporarily
  16. Cortisol, causes more sugars to go into the circulation, by converting fat and proteins.
  17. Increased risk for heart disease due to continued presence of stress factors
  18. Immune system can become depressed increasing risk of diseases, and decreasing body’s resistance
  19. Digestive system - cramps, stomach aches, increased risk for ulcers, constipation, diarrhea
  20. Mental Health
  21. Stress, HPA dysregulation and GI Problems
  22. Stress  sympathetic over-activity  depressed parasympathetic influence of the GI tract  multiple GI disorders.
  23. Reduced gastric acid production reduce secretin and CCK gallbladder suppression  fat malabsorption  Gallstone  fat soluble nutrients deficiency  depress normal physiology and indigestion.
  24. Malnutrition  lowered immune function  chronic infection and increase internal stress and maintain vicious cycles of illness
  25. IBS
  26. poorly understood condition relating to functional abnormality of lower GI
  27. 20% of the adults in the US suffered from it
  28. 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
  29. Diagnosed by ruling out physical causes
  30. No known cause, No known cure
  31. Meds for symptom relief-antispasmodic, laxative, antidepressants
  32. Certain foods can cause symptoms—sub-clinical gluten intolerance
  33. Food sensitivity and dysbiosis are considered suspects by many alternative health professionals
  34. Stress’ also considered as a major trigger
  35. Imbalance of gut hormones especially serotonin may be key to solve mystery
  36. Prozac can cause diarrhea and constipation depends on the dose.
  37. The drug, Zelnorm acts as a serotonin agonist, stimulates GI tract motion
  38. What in nature can cause an imbalance of the serotonin system? Any addictive stuff.
  39. Sugar is universal.
  40. Effects of Fat Malabsorption
  41. Your Gut—The Drug Maker
  42. brain contains receptors for benzodiazepine, a drug that relieves anxiety, suggesting that the body produces its own internal source of the drug
  43. 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.
  44. Could depression be caused by a distressed gut releasing too much benzodiazepine?
  45. Restore and Maintain Gut Health
  46. body is a self-regulating organism
  47. There are lots more that our body can do than our conscious mind can ever comprehend
  48. Innate intelligence
  49. Our ancestors did not have to study what to eat or what medications to use
  50. All they had to do was eat whatever mother nature provided for them—they stayed healthy
  51. how?
  52. Eat wholesome natural, organically grown foods
  53. Avoid all forms of processed foods, refined sugars and carbohydrates
  54. Minimize exposure to toxic chemicals and metals
  55. Get enough sleep, in total darkness
  56. Eat enough, but not excessive fiber: vegetables, nuts, seeds, whole grains and fruits
  57. Drink adequate but not excessive clean water, but don’t drink too much water with meals
  58. Chew slowly and thoroughly
  59. Eat until only 80% satisfy
  60. Do not eat while upset, worry or angry
  61. Do not eat within three hours of bed time
  62. Do not use drugs unnecessarily
  63. Use probiotics or lacto-fermented foods to replenish friendly flora
  64. Use coconut oil, raw cream or butter for their antimicrobialshort and medium chain fatty acids
  65. Avoid eating raw foods if any GI ailments present
  66. Eat with relaxing music and with loved ones, in silence
  67. Use nutritional, herbal and homeopathic supplements
  68. Exercise regularly, but not after 5 pm
  69. Avoid foods you are sensitive to
  70. Sleep between 10pm to 6am regularly

The 4R program - protocol to restore digestive health