Gastrointestinal Balance: Do you have the guts for health?

1. Gastrointestinal Balance:Do you have the guts for health? Mark Pettus MD, FACP February 18, 2014

2. I want to achieve immortality not through my work … I want to achieve it through not dying. Woody Allen

3. The Proposition • All health and disease are byproducts of complex individualized gene-environment interactions that may go back more than a generation before conception and continue throughout our lives. • Your genes i.e., your “Book of Life” have a Stone Age imperative, not often compatible with 21st century environmental inputs. • This incompatibility creates a distorted metabolic trajectory that forms the basis of chronic complex disease. • Through epigenomic alteration, our gene expression patterns can be profoundly modulated to promote optimal function and health. • This remains possible throughout life by aligning one’s environmental inputs with that which your genes are best suited for…this is the exit to a healthy life.

4. Learning Objectives • Examine the role that gastrointestinal health plays in the broader context of health, dis-ease, and quality of life. • Explore the connection between gastrointestinal health, your gut’s ecosystem, inflammation-immune regulation, and your nervous system. • Examine environmental inputs that lead to “leaky-ness” or increased permeability in the gut. • Review the “4R-Model” for gastrointestinal health

5. Digestive Disease in America • Impacts 60-70% Americans • GERD effects 45-60 million • 7-10% Americans experience heartburn at least daily • 20% (60 million) experience at least once monthly • Irritable bowel disease (IBS) effects 30-45 million • Gallstone disease 20-25 million • Diverticular Disease 20 to 40 million • Celiac estimated at 3 million (approx 1:100) • Gluten sensitivity as much as ? 10% of Americans • IBD 750,000 – 1 million • Colorectal Cancer approximately 260,000

6. The IMS reports that Americans spent $307 billion on prescription drugs in 2010. The 10 drugs on which we spent the most were: • Lipitor, a cholesterol-lowering statin drug -- $7.2 billion • Nexium, an antacid drug -- $6.3 billion • Plavix, a blood thinner -- $6.1 billion • Advair Diskus, an asthma inhaler -- $4.7 billion • Abilify, an antipsychotic drug -- $4.6 billion • Seroquel, an antipsychotic drug -- $4.4 billion • Singulair, an oral asthma drug -- $4.1 billion • Crestor, a cholesterol-lowering statin drug -- $3.8 billion • Actos, a diabetes drug -- $3.5 billion • Epogen, an injectable anemia drug -- $3.3 billion

7. Gut Health Mind-Brain-Body Immune/Inflammation

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

10. IBS associated with: • GERD • Interstitial cystitis • Fibromyalgia • Chronic Fatigue Syndrome • Disrupted sleep • Rosacea • Migraine headaches • Restless leg syndrome (RLS)

11. GERD: Do we have all wrong?

12. Celiac and gluten sensitivity associated with: • Thyroid disease • Neurologic diseases • Osteoporosis • Decreased fertility • Recurrent UTIs • Autoimmune disease • Skin disorders e.g. eczema, rosacea • RLS – restless leg syndrome

13. David Relman MD Clin Prof Med-ID, Prof Microbiology-Immunology Stanford Ecology of human indigenous microbiology and relationship to health and disease.

15. Irritable Bowel Syndrome • Most common GI functional disorder diagnosed by gastroenterologists affecting about 5-10% of the population with female predominance of 2-3:1 • Symptom complex including abdominal pain, altered bowel function, bloating, mucosal inflammation, exaggerated stress response, increases in plasma pro-inflammatory cytokines • Stress (including early life stress) plays a major role in the onset and exacerbation of symptoms in IBS • Recent studies have shown that there may be a brain-gut axis dysfunction involved in IBS • Treatment options for IBS are symptom based and include: • Laxatives • Loperamide (Imodium) • Antispasmodics • Antidepressants • Serotonin receptor agonists/ antaginsts

16. Increased Intestinal Permeability And molecular trafficking

18. Common causes of increased intestinal permeability • SAD: High animal fat, animal protein, high-sugar, low-fiber, processed diet • Overuse of medications such as NSAIDs, antibiotics, acid blockers, steroids e.g. prednisone, chemotherapy • Food sensitivities - allergies • Low-grade bug imbalances (dysbiosis) involving yeast, bacterial overgrowth (SIBO) • Toxins e.g. BPA, pthalates, pesticide residues • Stress or the brain-gut connection • Alcohol

19. Stress and the gut Stress Activation of the HPA axis (ie CRF, ACTH, cortisol) • Increase in gut permeability • Increase in mucosal inflammation • Changes in GI motor function • Changes in gut flora

28. The 4R Model

29. 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

30. 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.

31. 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

32. 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

35. Repair • Fiber: Consider psyllium or guar gum, 1 tsp in 8-10 oz of water • before each meal if not getting enough fiber. • Whole Food Nutrition: Incorporate a hypoallergenic, nutrient rich • diet. • Regular Exercise. • Zinc carnosine: 25-30 mg a day for one month. • Omega-3 fatty acids (EPA/ DHA) and/or Gamma Linolenic Acid • (Evening primrose Oil, Borage Oil or Black Currant Oil):Total of • 2 gms daily for one month. • L-Glutamine Powder: 5 gms twice daily for one month.

36. Relaxation

37. 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 • O-3 fish oils 4-6 grams/day EPA/DHA • Ginger – 1,000 to 2,000 mg daily • Glutamine 500-1,000 mg with meals • Magnesium citrate or glycinate 400 – 800 mg daily • Melatonin – 3-6 mg at bedtime for GERD • Zinc carnosine 15-30 mg daily • Vitamin D: 1,000 – 4,000 u/day to keep levels 40+

39. Thank you.