Gastrointestinal Balance: Managing Leaky Gut

1. Gastrointestinal Balance: Managing Leaky Gut Mark Pettus MD, FACP May 30, 2017

2. Disease (how things appear) Pre-diabetes, Diabetes, Obesity, Metabolic Syndrome, Heart Disease, Stroke, Depression, Autoimmunity, Cognitive decline-Alzheimer’s, Cancer Core Metabolic Imbalances (what drives them) Inflammation and Insulin Resistance Intestinal permeability-microbiome Root Causes (what are their origins) Gene-Epigenome-Environment Nutrition Movement Stress Response Environmental toxins Sleep Social Connection Trauma Conflict Management Stress Management Meaning in Work, Love, Play

3. Environment Life Epigenome Microbiome Consciousness-Spirit

5. The gut as an ecosystem • Over 1,000 species of bugs • 3+ lbs of bacteria • Gut “flora” when in balance facilitate: • -digestion • -detoxification • -production of vitamins • -produce healing metabolites • -regulate hormones

6. Problems with gut health can promote/worsen… • Allergy • Weight Gain • Asthma • Autoimmunity • Arthritis • Metabolic Bone disease • Skin problems • Mood disorders • Dementia • Cancer • Inflammation

8. Increased Intestinal Permeability And molecular trafficking

10. Common causes of increased intestinal permeability • SAD: Carbohydrate dense, high-sugar, low-fiber, processed diet; • Overuse of medications such as NSAIDs, antibiotics, acid blockers, steroids e.g. prednisone, chemotherapy • Food sensitivities – allergies e.g. gluten and casein • Low-grade bug imbalances (dysbiosis) involving yeast, bacterial overgrowth (SIBO) • Toxins e.g. BPA, pthalates, pesticide residues, glyphosate (GMO) • Stress or the brain-gut connection • C-section birth and formula feeding • Alcohol

11. Carbohydrate-dense foods • Major contributor of obesity, insulin resistance, changes in blood lipids, inflammation, and alterations of the organisms in the human microbiome • A huge area of opportunity in individuals with increased belly fat, pre-diabetes or diabetes…these are health features of carbohydrate intolerance. • For most, sugar and refined, grain-based foods are problematic: eliminate and observe.

12. Courtesy Ian Spreadbury PhD Cancer

13. Cell 150, 470–480, August 3, 2012 ª2012 Elsevier Inc.

20. Mechanisms that link alterations of the microbiome with weight and metabolism • Increased energy harvest from the diet • Altered fatty acid metabolism in liver, muscle, and fat tissue • Modification of gut hormones e.g. cholecystokinin, peptide YY and GLP-1 • Activation of LPS- TLR 4 axis and cytokine expression • Altered gut barrier function and molecular trafficking • Bile acid metabolism • SCFA production

21. Intestinal Permeability • Uncontrolled Trafficking of Molecules • Food sensitivites • Dysbiosis • SIBO • Acid suppression • Stress response • Environmental toxins • Medications e.g. NSAIDs

23. Noteworthy contributions to alterations of the human microbiome • Dietary changes e.g. refined, processed simple starches and sugars “carbohydrate-dense” foods • C-sections • Formula feeding • Marked decreases in fermentable fiber • Antibiotic use in prescriptions and in industrialized foods • Glyphosate as an anti-microbial • Hygiene hypothesis • Prior GI infections; H. pylori; systemic infections SIBO-small intestinal bacterial overgrowth • Medications e.g. PPIs, steroids, chemotherapy

24. Courtesy Kathie Swift MS RDN LDN FAND EBQ

25. Remove • Foods that one may be intolerant to (elimination diet: • start with gluten and dairy). • Medications that may negatively influence an optimal • GI environment (such as PPIs, H2 blockers, NSAIDs, • antibiotics, steroids). • For IBS or persistent dyspepsia, consider SIBO and • treat with xifaxin 200 mg, two tabs twice daily for • 10-14 days • Consider a 2-4 week trial with Diflucan for yeast • Stress: how we interpret and respond

26. Replace For persistent dyspepsia, indigestion, or long-term use of stomach acid suppression consider digestive enzymes to promote better macronutirent breakdown. These are usually plant-based (papaya, pineapple) compounds e.g. bromelain taken with each meal.

27. Re-populate • Administer probiotics from the following three families that have been found to be beneficial for GI function: Bifidobacteria, Lactobacilli, and Saccharomyces. • Administer prebiotics (food that promotes beneficial bacterial growth) such as bananas, Jerusalem artichoke, onions, asparagus and garlic, whole grains. • Target at least 20-30 billion cfus/day

28. Courtesy Kathie Swift MS RDN LDN FAND EBQ

29. Courtesy Kathie Swift MS RDN LDN FAND EBQ

30. Repair…nutritionally • Eat whole, fresh, unprocessed foods-seasonal, organic, and local • Fiber supports gut flora • Avoid common food allergens • Eat foods that taste good and allow your taste buds time to get used to new foods • Eat in rhythm with meals scheduled at regular intervals throughout the day • Eat in a mindful, relaxed state • Stay a little hungry • Eat foods YOU prepare

32. Relaxation Soft-Belly Breath

33. Lifestyle changes to bring diversity and balance to the gut microbiome • Diminish sugar and processed refined, carbohydrate-dense foods. Grains, gluten and glyphosate exposures • Increase fermentable plant-based fiber and fermentable foods • Whenever possible, go organic, GMO-free (glyphosate) • Cautious with prescribed antibiotics and feedlot meats, poultry, and eggs • Minimize NNS, emulsifiers, thickeners • Consider testing, diagnosis and treatment of dysbiosis-SIBO (breath testing; CDSA; H. pylori) • Probiotics • Taper, d/c PPIs • ? Future of fecal microbiota transplants

34. Supplements with some supportive research • Aloe Vera juice – 3 oz. twice daily • dgl-Licorice for GERD – 500mg chewtabs with meals • Digestive enzymes – 1-2 caps with meals • Glucomannan or Acacia Gum (prebiotics) • Magnesium 400-600 mg at bedtime • VSL#3 probiotics: 2/day with bkfst for 1 month, then 1/day • Zinc carnosine 15-30 mg daily • Vitamin D: 2,000 – 4,000 u/day to keep levels 40-60

35. Thank You