Gastrointestinal Balance: Managing Leaky Gut

1. Gastrointestinal Balance: Managing Leaky Gut Mark Pettus MD, FACP December 5, 2017

2. Environment Life Epigenome Microbiome Consciousness-Spirit

3. 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 Stress Response Mitochondrial disruption 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

5. The gut as an ecosystem • Over 1,000 species of bugs • 4+ lbs of bacteria • Gut “flora” when in balance facilitate: • -digestion • -train our immune system • -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. Intestinal Permeability • Uncontrolled Trafficking of Molecules • Food sensitivites • Lectins • Dysbiosis • SIBO • Acid suppression • Stress response • Environmental toxins • Medications e.g. NSAIDs

12. 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.

14. Courtesy Ian Spreadbury PhD Cancer

15. 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

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

24. 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

26. 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 with neomycin • Consider a 2-4 week trial with Diflucan for yeast • Stress: how we interpret and respond

27. 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.

28. 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, plant-based fermentable fiber e.g. Jerusalem artichoke, onions, asparagus and garlic, cruciferous, resistant starch, leeks, berries. • Target at least 20-30 billion cfus/day

29. 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

31. Relaxation Soft-Belly Breath

32. 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

33. 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 (Guar Gum) • 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

34. Thank You