Detoxification and HPA Axis Dysfunction

1. Detoxification andHPA Axis Dysfunction Christopher Mote, DO, DC

2. Our Presenter: Christopher Mote, DC, DO • 11 years as licensed chiropractic physician • 10 years practicing exclusively Functional Medicine • 6 years in Clinical Support role for BioHealth Diagnostics Lab and Ortho Molecular Products, Inc. • DO degree from Midwestern University, Chicago College of Osteopathic Medicine, May 2009 • Family Medicine Resident, PG-II, Resurrection Medical Center, Chicago, IL

3. Detoxification • Detoxification and Elimination overview • Indications for detox prescription/protocol • Impact of HPA axis dysfunction on detoxification • Impact of GI function on detoxification • Protocols and pearls

4. Functions of Liver • Filtration and recycling of proteins • Repackaging of micronutrients from gut • Stores glycogen and energy production • Metabolism: i.e.. steroid hormones • Elimination – production of bile • Major organ directing and modulating elimination of metabolically undesirable compounds (MUC)

5. MUC Formation vs. Elimination • Toxins include environmental as well as in vivo production • When toxin levels are in excess of our body’s capacity to remove them, toxins build up and are stored until they are removed • Toxins are “fat soluble” – they are attracted to the fatty portion of cells throughout the body

6. Sources of MUC Environmental In Vivo Increased antigen load through mucosal membranes Leaching of heavy metals from mouth Chronic “smoldering” infections Hormone excess • Polluted air from factories • Auto exhaust/inhalants • Solvents (paint and cleaning products) • Heavy metals • Pesticides, herbicides, insecticides • Radiation

7. Detoxification Pathway

8. Why Detox Your Patients?Symptoms/Conditions indicative of poor liver function: • Headaches • Chronic neurologic illness • Depression, anxiety, brain fog, poor memory • Fatigue • Skin problems: acne, eczema, rash, hives, etc • Diffuse muscle/joint pain • Chemical sensitivities • GI symptoms of bloating, gas, constipation, diarrhea • Obesity • Complex chronic illness • Hormone imbalances

9. Why Detox Your Patients?Lab values correlating with poor liver function: Direct Measure Indirect Measure ALT/AST/GGTP Secretory IgA Mucosal permeability profiles Total Immunoglobulins Adrenal profiles • Urinary Bile Acid Sulfates • Detox Enzymes: • SOD • MTHFR • COMT • GSTM1 • GSTP1 Other reasons to detoxify…

10. “Doctor, do you think I need a detox?” • Patient’s frequently ask about it • Have read something or talked with a friend • “What makes you ask? What do you know about it?” • Symptoms on presentation can indicate need: • Fatigue and headache • Chemical sensitivities and brain fog • Lab Markers • Urinary bile acid sulfates, LFTs • HPA axis dysfunction, beta-glucaronidase

11. “…do I need a detox”? • What do you know? Where did you learn? • What do you want it to do for you? • Have you or someone you know done it? • Are you willing to… It is essential to get and set expectations.

12. “I’m recommending…” • “I recommend a detox program for you.” • The key symptoms from your questionnaire I want to address include… • The important markers indicating you need one include…

13. What’s really happening? Increased toxic burden OR Decreased detoxification capacity …YES

14. Increased Antigen Load • History to uncover environmental exposure • Chemical exposures • Occupational hazards • Mold or water damage • Poly pharmacy • Alcohol, caffeine, tobacco, recreational drugs …less common

15. Increased Antigen Load What is the function of the mucosal barrier?

16. Increased Antigen Load Diagram from BHD/Dr A. Vojdani

17. Labs for Increased Antigen Load • Evidence of Increased Mucosal Permeability • Total immunoglobulins elevated • Secretory IgA depression • Elevated urinary lactulose and mannitol • Delayed food allergy testing positive • Intestinal Barrier Function Screen – BHD#304

18. Increased Antigen Load • Mucosal barrier function & antigen penetration • Toxins • Medications • Pathogens • Gluten/Dairy • Stress – HPA axis activation • Secretory IgA suppression • Cytokine-driven inflammation • Loss of tight junctions • Breakdown of function/integrity • Increased Permeability • Increased antigen load • Increased immunoglobulin and cytokine response • Increased immune complex formation • Compromised hepatic function • Immune complex deposition and autoimmunity

19. What’s really happening? Increased toxic burden OR Decreased detoxification capacity …YES

20. Cortisol Control of Gene Transcription

21. Cortisol Driven Global Dysfunction • Neurons ----> Neurotransmitters • Glands ----> Hormones/Enzymes • Immunocytes ----> Antibodies • Mitochondria ----> ATP • Hepatocytes ----> Cytochrome enzymes

22. HPA Axis/Cortisol Influence #1 Elevated/Low Cortisol results in lower SIgA and increased antigen penetration & load #2 Low Cortisol inhibits cytochrome enzyme production needed for Phase I #3 Low Cortisol inhibits ATP production and mitochondrial function needed for Phase II

23. Lab Assessments: • HPA axis function and Cortisol output: • ARK205 or other salivary cortisol profile • Mucosal Permeability: • Secretory IgA (can be added to ARK205) • Elevated lactulose/mannitol • Delayed Food allergy panels • Total immunoglobulins elevated • Intestinal Barrier Function Screen • Liver Function: • NeuroGenomic Profile – enzyme levels for Phase II • UBAS – overall liver function

24. Detoxify to Maximize Function • 7-day protocol • Days 1 & 2: Fasting (can do V-8 infusion of needed) • Core Restore: 2 scoops with 8oz chilled liquidQ12h • AlphaBase: 2 caps am and noon • Days 3-7: Meal plan (see Core Restore BT patient guide) • Core Restore: 2 scoops BID • AlphaBase: 2 caps am and noon • Phytocore: 2 caps am and noon • May continue for 14 – 28 days

25. Products • Core Restore: provides nutrient base for detoxification protocol, boost biotransformation (mostly phase II) and provide enough fiber to ensure appropriate binding of toxins within the stool • Phytocore: boost phase I and II detoxification pathways to stimulate the detoxification process once the program has started • Alpha Base: multivitamin/mineral product is provided (in convenient blister cards) to ensure the patient is provided with the vitamin and mineral cofactors necessary for supporting proper detoxification

26. Core Restore BT Patient Guide

27. Marilyn 54 yr old with joint pain • Chronic diffuse joint pain for last 7 years • Headaches weekly, both tension and migraine type • Daily fatigue, especially after noon • Mild depression as in SAD • Constipation alternating with diarrhea • Dark circles/bags under her eyes • Works long hours as retail manager • BMI 29, borderline HTN

28. Marilyn’s labs • CBC/Chem shows only low mild IDA, low A/G ratio, TSH is normal • Salivary adrenal profile demonstrating Stage II with high normal androgens: DHEA, E2, testosterone • UBAS @ 18 (normal is <12, ideal <9) • Stool test positive for H.pylori

29. Marilyn’s Health Plan • Begin 14 day Core Restore detox • Initially pain, headache, and sleep worsened. By day 8 patient began to feel some reduction in symptoms. • At day 14 she reported 50% reduction in her pain, more clarity of thought, less nasal congestion, and headaches that were less intense.

30. Marilyn • Diet after day 14 was to be limited to low glycemic fruits and unlimited vegetables. No protein was added back initially. • Treatment for H.pylori using 14 day triple therapy was initiated. • Pain worsened as did fatigue and some abdominal cramping with looser stools.

31. Marilyn • After 14 days of antibiotics patient started on OrthoBiotic 3 caps a day along Pyloricil, 2 caps daily and ARK protocol for adrenal support. • Stools began to normalize, headaches nearly resolved and pain was now 25% of initial. • After 6 wks the stool was negative for H.pylori and small portions of protein were added back along with Digestzyme, 1 cap with each meal.

32. Marilyn • At 8 wks patient still with some pain, fatigue, and down mood • UBAS was repeated and still high at 11. • Patient did another 7 day detox and at day 5 says she felt no further pain. • She was continued on Phytocore 2 caps a day for 4 weeks along with ARK protocol and Digestzyme with each meal.

33. Marilyn • At 13 wks post H.pylori treatment patient returned with considerable enthusiasm: sleeping 7+ hr, refreshed, good energy in afternoon. Still no pain and no headache for 4 wks. • The staff who weighed the patient 19# less than initial visit remarked how great her skin, especially under the eyes, looked. • 3rd UBAS now 5, Adrenals with normal androgens • Stools now formed, continued on Digestzyme and Pyloricil for 3 months.

34. Thank You Questions?

35. A system for doctors to promote detoxification with an emphasis on group sessions • The all-new Detox with your Doctor Resource Bundle includes: • All-new Core Restore Roadmap • DVD presentation and presentation slides • Kick-off meeting Agenda • “Simple Steps” to promoting and running a group detox event • Promotional and Daily Encouragement Emails • 2 Customized signs and a pdf flyer for promoting the event • “2nd Opinion” Patient Newsletter