mind, mood & food webinar series...trigger intestinal permeability - aka “leaky gut” ......
TRANSCRIPT
Mind,Mood&FoodWebinarSeries
PresentedbytheCenterforMind-BodyMedicineandhostedbyKathieMadonnaSwift,MS,RDN,LDN.
LeakyGut:FactorFantasy?
Presentedby:SheilaDean,DSc,RDN,LDN,CCN,CDE,IFMCP
www.IFNAcademy.com
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Disclosure
• Co-founderoftheIntegrativeandFunctionalNutritionAcademy™• IFNA™ isanAccreditedProviderofCPEUsbytheCDR• IFNA™ offerstheIFNCP™,IntegrativeandFunctionalNutritionCertifiedPractitionerAdvancedPracticeCredential
LearningObjectives
• Describetherelationshipbetweenfoodexposure(i.e.gluten)andintestinalpermeability• Explaintherelationshipbetweenintestinalpermeabilityandinflammation• Discusstherelationshipbetweeninflammationandthespectrumofchronicdisease• Identifyamedicalnutritiontherapy(MNT)basedtreatmentplan
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Imagesource:EatingWell,July/August2016pg 27
“Leakygut”=Intestinal
permeability
TheBigPicture
Trigger intestinalpermeability- aka“leakygut”
Leakygut Immune/Inflammatoryresponse
Immune/inflammatoryresponse Chronicdisease
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Source:Bischoff,etalBMCGastroenterology,2014(seepreviousslide)8
LearningObjectives
• Describetherelationshipbetweenfoodexposure(i.e.gluten)andintestinalpermeability• Explaintherelationshipbetweenintestinalpermeabilityandinflammation• Discusstherelationshipbetweeninflammationandthespectrumofchronicdisease• Identifyamedicalnutritiontherapy(MNT)basedtreatmentplan
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Source:http://glutensensitivity.net/VojdaniDiagrams.htm#HG 10
Wenowrecognise thatthefunctionalstateofthetightjunction,onceconsideredastaticparameter,isinrealityincrediblydynamic.Epithelialtightjunctionsopenandcloseallthetimeinresponsetoavarietyofstimuli.These
includedietarystate,humoralorneuronalsignals,inflammatorymediators,mastcellproducts,andavarietyofcellularpathwaysthatcanbe
usurpedbymicrobialorviralpathogens.11
Zonulin istheonlyphysiologicmodulatorofintercellulartightjunctionsdescribedsofarthatisinvolvedinthetraffickingofmacromoleculesandthereforeintolerance/immuneresponsebalance.Whenthezonulin pathwayisderegulatedingeneticallysusceptibleindividuals,autoimmunedisorderscanoccur.
“TID”triggersofintestinalpermeability
ToxinsInfection
Dietaryproteins
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GlyphosateTestingnowavailable
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“TID”triggersofintestinalpermeability
ToxinsInfection
Dietaryproteins
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“ThisfindingsupportstheviewthatIPincreasesduringthecourseofprotozoaninfectionswhichcausedamagetotheintestinalwallwhilenon-pathogenicprotozoaninfectionshavenoeffectonIP.TheincreaseinIPinpatientswith B.hominis bringsforththeideathat B.hominis canbeapathogenicprotozoan.”
..thesestudiesshowforthefirsttimethatLPScausesanincreaseinintestinalpermeability..
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Whenthefinelytunedzonulin pathwayisderegulatedingeneticallysusceptibleindividuals,bothintestinalandextraintestinalautoimmune,inflammatory,andneoplasticdisorderscanoccur.
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“TID”triggersofintestinalpermeability
ToxinsInfection
Dietaryproteins
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Justthebasics:Whatisgluten?
• Glutenisamixtureofproteinsfoundinwheatandrelatedgrains,includingalltheirspeciesandhybrids.Itiscomposedoftwoprimarysubfractions:• Prolamines• Glutelins
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TheProlamine FractionofProteinsinGrains
GRAIN PROLAMINE %TOTALPROTEIN
Wheat Gliadin 69
Rye Secalinin 30-50
Oats Avenin 16
Barley Hordein 46-52
Millet Panicin 40
Corn Zien 55
Rice Orzenin 5
Sorgum Kafirin 52
Source:http://www.nutramed.com/celiac/gluten.htm 29
SpectrumofGlutenRelatedDisorders
Sapone A.etal.Spectrumofgluten-relateddisorders:consensusonnewnomenclatureandclassification.BMCMedicine.2012,10:13.30
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Howmanyknoworsuspectasensitivitytogluten?
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Eur J of Gastro & Hepatology 2014, Vol 26 No 1
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Thereisanemergingproblemencounteredinclinicalpracticeofpatientscomplainingofgluten-relatedsymptoms
despitetheabsenceofdiagnosticmarkersforCD,suchasnegativecoeliacserologyandnormalduodenalbiopsies.
Eur J of Gastro & Hepatology 2014, Vol 26 No 1
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Thesepatientsposeaclinicaldilemmatohealthcareprofessionalsandinthepasthavebeendescribedasbelongingtoa ‘noman’sland’duetothediagnostic
uncertainty.
Ok,soshouldIgoglutenfree?
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Source:ReillyN.TheGlutenFreeDiet:RecognizingFact,FictionandFad.JournalofPediatrics. 2016.DOI: http://dx.doi.org/10.1016/j.jpeds.2016.04.014
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British Journal of Nutrition (2010), 104, 773
ItappearsthataGFDinbothcoeliacandnon-coeliacsubjectscouldproducesimilar,potentiallyadversechangesinthemicrobiotasolelyonthebasisofa
markedreductioninintakeofnaturallyoccurringfructans whichhaveprebioticaction.
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Br J of Nutrition (2009), 102, 1154–1160
Therefore,theGFDledtoreductions inbeneficialgutbacteriapopulationsandreductionsintheabilityoffaecal samplestostimulatethehost’simmunity.
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British Journal of Nutrition (2010), 104, 773
Provisionofgluten-freebutprebiotic-richfoodsand/orasupplementoffructan-typeprebioticscouldavoidthissituationand,insodoing,provide
importantsupporttotheintestinalmicrobiotaaswellasimportantnutritionalguidanceforthecoeliacpatient.
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Alargenumberofhumaninterventionstudieshavebeenperformedthathavedemonstratedthatdietaryconsumptionofcertainfoodproductscanresultinstatisticallysignificantchangesinthecompositionofthegutmicrobiotainlinewiththeprebiotic
concept.Thustheprebioticeffectisnowawell-establishedscientificfact.
Asaresultoftheresearchactivitythatfollowedthepublicationoftheprebioticconcept15yearsago,ithasbecomeclearthatproductsthatcauseaselectivemodificationinthegutmicrobiota'scompositionand/oractivity(ies)andthusstrengthensnormobiosis couldeitherinducebeneficialphysiologicaleffectsinthecolonandalsoinextra-intestinal
compartmentsorcontributetowardsreducingtheriskofdysbiosis andassociatedintestinalandsystemicpathologies. 41
Theuseof probiotics seemstoreducetheinflammatoryresponseandrestoreanormalproportionofbeneficialbacteriainthegastrointestinaltract.
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Thegrainwithtwofaces
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“Conclusions:IncreasedintestinalpermeabilityaftergliadinexposureoccursinALLindividuals.”
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..wheatalsoprovidessubstantialamountsofanumberofcomponentswhichareessentialorbeneficialforhealth,notablyprotein,vitamins(notablyBvitamins),dietaryfiber,andphytochemicals..
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LearningObjectives
• Describetherelationshipbetweenfoodexposure(i.e.gluten)andintestinalpermeability• Explaintherelationshipbetweenintestinalpermeabilityandinflammation• Discusstherelationshipbetweeninflammationandthespectrumofchronicdisease• Identifyamedicalnutritiontherapy(MNT)basedtreatmentplan
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Theincreaseinintestinalpermeabilityismostlikelycausedbyinflammation-inducedparacellular permeability,ratherthan
ischemia-mediatedenterocytedamage.48
Specificgutbacteriaseemtoserveaslipopolysaccharide(LPS)sourcesandseveralreportsclaimaroleforincreasedintestinalpermeabilityinthe
genesisofmetabolicdisorders….InAsianIndianswhoareconsideredhighlyinsulinresistant,thecirculatoryLPSlevels,LPSactivity,andZO-1were
significantlyincreasedinpatientswithtype2diabetesandshowedpositivecorrelationwithinflammatorymarkersandpoorglycemic/lipidcontrol.
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Recentstudiesinvestigatingtheunderlyingmechanismsinvolvedindiseasedevelopmentindiabetespointtotheroleofthedysregulationoftheintestinalbarrier.Viaalterationsintheintestinalpermeability,
intestinalbarrierfunctionbecomescompromisedwherebyaccessofinfectiousagentsanddietaryantigenstomucosalimmuneelementsisfacilitated,whichmayeventuallyleadtoimmunereactionswithdamageto
pancreaticbetacellsandcanleadtoincreasedcytokineproductionwithconsequentinsulinresistance.
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Itisrecognizedthatachroniclow-gradeinflammationandanactivationoftheimmune
system areinvolvedinthepathogenesisofobesity-relatedinsulinresistanceandtype2diabetes.
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“Researchresultsseemtobeverypromisingandindicatethepossibilityofimprovedclinicaloutcomesinsomepatientswithschizophreniabymodifyingdiet,use
ofprobiotics,andtheimplementationofantibiotictherapyofspecifictreatmentgroups.”
LearningObjectives
• Describetherelationshipbetweenfoodexposure(i.e.gluten)andintestinalpermeability• Explaintherelationshipbetweenintestinalpermeabilityandinflammation• Discusstherelationshipbetweeninflammationandthespectrumofchronicdisease• Identifyamedicalnutritiontherapy(MNT)basedtreatmentplan
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1. Removea. Toxinsb. Infectionc. Dietarytriggers
2. Replacea. HCLb. Digestiveenzymes
3. Reinoculatea. probiotics
4. Repaira. Glutamine/SCFAsb. Fishoilsc. curcumin
HealingLeakyGutwiththe4RGIRestorationProtocol
Source:InstituteforFunctionalMedicine
Whattoconsidereliminating:• Gluten(r/oceliacdiseasefirst,ifpossible)• Dairy• Corn?Soy?Grains?animalprotein?• Refinedsugar• Infection• Toxins(alcohol,preservatives,smoking,stress)
Whattoconsideradding:• Betaine HCL,broadspectrumdigestiveenzymes• Probiotics/prebiotics/fermentedfoods• Glutamine(doselowandgoslow)/zinccarnosine• Methylatednutrients(B2,B6,folate,B12,CoQ10)• Omega-3fishoils• Fiberrichfoods/prebiotics• Antioxidant/phytochemicalrichfoods(i.e.freshfruitsandvegetables,seeds,nuts,legumes,etc.)
Onceyouhaveagoodhistory,testresultsetc.,youcanformulatetherestofyourNutritionCarePlan
Imagesource:www.IFNAcademy.com
KeyTakeaways
• Impairedintestinalpermeabilityisrealphenomenonthatispartofthe“3leggedstool”thatleadstoautoimmunity
• Triggerscanincludetoxins,infection,diet(TID)
• Impairedintestinalpermeabilitycanbehealedusingthe4Rprotocol
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Presentersfromlefttoright:Alessio Fasano,MD;SheilaDean,DSc,RDN,AndreaScaramuzza,MD76th ADAAnnualSymposium- June12,2016
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Mind,Mood&Food
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OptimalNutritionforBody&Brain
April15-20,2018Esalen InstituteBigSur,CA
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