Showing posts with label leaky gut. Show all posts
Showing posts with label leaky gut. Show all posts

19 July 2015

Diet-induced Changes in the Gut Micro-biome

Diet-Induced Dysbiosis of the Intestinal Microbiota and the Effects on Immunity and Disease

Read full article HERE
Kirsty Brown  , Daniella DeCoffe  , Erin Molcan and Deanna L. Gibson  *
Department of Biology, University of British Columbia Okanagan, Kelowna, BC V1V 1V7, Canada;

Abstract

The gastrointestinal (GI) microbiota is the collection of microbes which reside in the GI tract and represents the largest source of non-self antigens in the human body. The GI tract functions as a major immunological organ as it must maintain tolerance to commensal and dietary antigens while remaining responsive to pathogenic stimuli. If this balance is disrupted, inappropriate inflammatory processes can result, leading to host cell damage and/or autoimmunity. Evidence suggests that the composition of the intestinal microbiota can influence susceptibility to chronic disease of the intestinal tract including ulcerative colitis, Crohn’s disease, celiac disease and irritable bowel syndrome, as well as more systemic diseases such as obesity, type 1 diabetes and type 2 diabetes. Interestingly, a considerable shift in diet has coincided with increased incidence of many of these inflammatory diseases. It was originally believed that the composition of the intestinal microbiota was relatively stable from early childhood; however, recent evidence suggests that diet can cause dysbiosis, an alteration in the composition of the microbiota, which could lead to aberrant immune responses. The role of the microbiota and the potential for diet-induced dysbiosis in inflammatory conditions of the GI tract and systemic diseases will be discussed.
Screen Shot 2015-07-17 at 9.41.13 PM

Microbial changes in the GI tract have profound effects on host inflammatory and metabolic responses. For example, protein-rich diets increase the activity of bacterial enzymes such as β-glucuronidase, azoreductase and nitroreductase, which produce toxic metabolites that trigger inflammatory responses. Because of the intricate balance that exists within the microbiota, alterations in one group or species may not only affect the host directly, but can also disrupt the entire microbial community. For example, members from the phyla Firmicutes, Actinobacteria, Verrucomicrobium and Bacteroidetes can degrade complex carbohydrates not absorbed by the host and can also inhibit the growth of opportunistic pathogens such as Clostridium spp. and members of Enterobacteriaceae like E. coli . Dysbiosis can also alter the metabolic activity of other members of the microbiota in the gut. Thus, it is conceivable that some diets promote the growth of microbes that could have detrimental effects on their host while other dietary factors could promote beneficial microbes. It is unknown whether diet-induced dysbiosis is a transient or long-term event. If dysbiosis is a long-term event, then postnatal nutrition could be used to promote changes in the microbiota early in life during the development of a more stable microbiota. In support of this, consumption of formula supplemented with fish oil has the capacity to alter the microbial composition in the infant; however, it is unknown if these microbial changes would be long lasting or transient. Although this study did not identify the specific microbes that changed, nor did it examine the effect on intestinal immunity, it does suggest that the microbiota could be modified through dietary factors to enrich beneficial microbes and prevent diseases associated with dysbiosis.

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24 October 2014

How to Heal a Leaky Gut, Part II


Did you miss my first Leaky Gut Article?! Read more here


So now you may be wondering if you have leaky gut...


Food allergies, toxins, sugar, antibiotics, parasites and stress can wreak havoc with your gastrointestinal system, upsetting the balance in your intestine as well as allowing harmful substances to enter the system. Gas, bloating, diarrhea, constipation or abdominal discomfort may be the first clue that something is wrong with the digestive tract, but did you know allergies
or even lack of energy and fatigue can often be traced to digestive problems as well?

Normally the gastrointestinal epithelium provides a semi-permeable barrier with allows nutrients to be absorbed while preventing larger molecules from crossing into the bloodstream. When this lining becomes inflamed or damaged, then the barrier becomes "leaky". The fallout results in larger, undigested food molecules and other “bad stuff” (yeast, toxins, and all other forms of waste) that your body normally doesn’t allow through, to flow freely into your bloodstream.

Causes of increased intestinal hyperpermeability or "leaky gut":

  • Medications (NSAIDS) like ibuprofen and motrin
  • Microbial overgrowth or infection
  • Parasite infections
  • Fungal overgrowth (Candida)
  • Ingestion of allergenic foods
  • Maldigestion/malabsorption (pancreatic insufficieny or low HCl)
  • Radiation therapy or chemotherapy
  • Stress
  • Aging
  • IgA deficiency
  • Chronic alcohol intake
  • Excessive or strenuous exercise
  • Inflammatory bowel disease - Crohn's or Ulcerative colitis
The small and large intestines contains numerous dietary and bacterial products with toxic properties. These include bacteria, bacterial cell wall (LPS), peptides, and bacterial antigens capable of inducing antibodies which may cross-react with human tissues.... when these antibodies react, they may form systemic immune complexes which can circulate and deposit in tissues far away from the gut.

Abnormalities of the gut lining barrier lead to increased uptake of inflammatory molecules and pathogenic bacteria. With inflammation & injury to the gut lininng, mucosal absorption of normally-excluded substances increases dramatically. Intestinal inflammation enhances the uptake and distribution of potentially injurious bacteria and proteins .

Leaky Gut is seen in disorders such as:

  • Inflammatory bowel disease (Crohn's & Colitis)
  • Inflammatory joint disease
  • Food allergy
  • Celiac disease
  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • Reiter’s syndrome
  • Eczema & psoriasis
  • Bipolar, depression and schizophrenia
  • Allergies and asthma
  • Autoimmune thyroiditis
  • Multiple sclerosis
  • Autoimmune liver & gallbladder disease

So how do we test for "Leaky Gut"?

Small molecules (glucose or mannitol) readily penetrate cells and passively diffuse through them. Larger molecules such as lactulose are normally are normally not able to diffuse through the cell. If the tight junctions between the cells are functioning properly, they will prevent the lactulose from leaking through. The Intestinal Permeability Test directly measures the ability these two sugar molecules—mannitol and lactulose—to permeate the intestinal mucosa.

Mannitol is readily absorbed and serves as a marker of transcellular uptake. Lactulose is only slightly absorbed and serves as a marker for mucosal integrity (ability of those "tight junctions" to keep out the bad stuff) The test is a 6 hour urine test that compares ratios of the two substances.

For more info:

Genova Diagnostics Intestinal Permeability Assessment
You will need to contact your functional medicine physician in order to order the test.
Now for some treatment options for this leaky gut!

Nutritional Support

  1. Glutamine, an amino acid, has been shown to reverse intestinal mucosal damage from various insults. Glutamine is the principle fuel used by the upper intestinal tract to repair and heal.
  2. Agents that stimulate protective mucus secretion may also help with the healing. Some common ones I use are marshmallow root extract and deglycyrrhizinated licorice (DGL) extract.
  3. Probiotics are essential! Lactobacillus casei, bifidobacter species, and saccromyces boulardii, a beneficial type of yeast are all important to restore gut health.
  4. Fish oil can be very helpful in the treatment of intestinal inflammation by decreasing inflammatory prostaglandins. EPA and DHA should be used in the range of 2-4gm daily
  5. Quercetin functions as a natural mast cell stabilizer and decrease release of histmine which contributes to inflammation & injury. To be effective, quercetin should be used in powder form and taken 3-6gm daily.
  6. Vitamins A and D are critical to supporting secretory IgA function and restoring the mucosal immune system. Ask your doctor for specific doses...

To Decrease Toxic Load:

  • Eliminate all known foods that you are sensitive to. This can be determined through a comprehensive elimination diet or IgG/IgE food tests on the blood.
  • Avoid alcohol, NSAIDS (ibuprofen, motrin, alleve), and minimize other medications.
  • Bentonite clay is a well-known intestinal adsorbent which absorbs numerous toxins, endotoxins and bacteria. Its value in permeability alterations may result from lowering the toxin load in the lumen, thus facilitating repair. I also frequently recommend Upgraded charcoal tabs for the same purpose.
  • HCI and digestive enzymes such as plant enzymes, pepsin and pancreatin might help to lessen the antigenic load or toxic molecules being presented on the intestinal lining.

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Photo courtesy of www.freedigitalphotos.net

16 May 2014

6 Signs that SIBO might be the root cause of your IBS

Photo courtesy of www.freedigitalphotos.net

Studies show that over 50% of patients diagnosed with IBS actually have an underlying imbalance called SIBO, or small intestinal bacterial overgrowth. The majority of our gut bacteria should be in the colon. When the bacteria migrate backwards into the small bowel or when there is low stomach acid or poor pancreatic enzyme production, bacteria in the small bowel can overgrow and cause symptoms, such as diarrhea, gas, or bloating.

Six signs you might have SIBO

  1. You notice that fiber worsens your constipation
  2. You notice an improvement in IBS symptoms when taking antibiotics
  3. You feel more gas and bloating when you take probiotics that contain prebiotics
  4. You are celiac or gluten intolerant and do not have 100% resolution of symptoms on a gluten-free diet
  5. You develop chronic symptoms of gas, bloating, constipation or diarrhea after taking pain medications, like opiates.
  6. Your blood work shows chronically low iron or ferratin with no known cause

Top 6 Symptoms of SIBO

  1. Abdominal bloating and distention
  2. Constipation 
  3. Diarrhea
  4. Abdominal pain or discomfort
  5.  Acid reflux or heartburn
  6. Excessive gas or belching

How do I know this isn’t just leaky gut?


While SIBO usually manifests with local GI symptoms, a leaky gut will manifest with systemic complaints that affect the immune system. Keep in mind that is is not uncommon to have both SIBO and leaky gut simultaneously. And very often if you have SIBO for a long period of time, you will develop a leaky gut.

Here are some systemic signs of a leaky gut:

  • Multiple food sensitivities
  • Skin rashes, acne or rosacea
  • Respiratory symptoms, like asthma
  • Allergic symptoms or increase in seasonal allergies
  • Fatigue
  • Brain fog or poor concentration, especially after meals
  • Any autoimmune disease
  • Joint pain or arthritis
  • Headaches or migraines
Remember SIBO can cause leaky gut syndrome but not everyone with SIBO has leaky gut. About half of the patients diagnosed with SIBO will also have leaky gut. Most of the time if SIBO is treated, leaky gut will heal itself!

10 conditions that may predispose you to have SIBO

  1. Hypochlorhydria (low stomach acid)
  2. Pancreatic insufficiency
  3. Decreased motility in small intestine
  4. Bowel obstruction
  5. Diverticula 
  6. Surgical bowel resection or bariatric surgery 
  7. Food poisoning (Post infectious IBS)
  8. Nerve damage that affects the GI tract
  9. Drugs, like opiates 
  10. Any disease that slows motility (diabetes, hypothyroid)

Other disorders that may be associated with SIBO


  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • Scleroderma
  • Hashimoto’s thyroiditis
  • Rosacea
  • Restless leg syndrome
  • Pancreatic insufficiency
  • Liver disease
  • Diabetes
  • Crohn’s disease
  • Celiac disease
  • Fibromyalgia
  • Kidney failure
  • Liver disease
  • Diverticulosis


How to Diagnose SIBO


Ask your doctor to order the Lactulose Breath Test (preferred over glucose as it will test the entire small bowel vs. just duodenum). You may also need to check a comprehensive stool analysis and urinary organic acids, which may point in the direction of other dysbiosis but are not directly assessing small bowel bacterial overgrowth

How do we treat SIBO?

1. Diet options
2. Antibiotics
  • Xifaxan
3. Dr. Jill’s favorite antimicrobial herbs

Treating SIBO successfully is not always easy and may involve major dietary changes and medication or herbal treatment for an extended period of time. However, getting the balance of your gut microbes healthy will likely prove to be the most important step in regaining your health and vitality! I know it was in my case… if you haven't read My Story, read more here.

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14 July 2013

Zonulin & Leaky Gut: A discovery that changed the way we view inflammation, autoimmune disease and cancer!

An amazing discovery a few years ago revolutionized our ability to understand the gut and permeability and how this impacts a wide range of health conditions from cancer to autoimmune disease to inflammation and food sensitivities. 

This little molecule, zonulin, has quite a story...


Zonulin is the "doorway" to leaky gut

Zonulin opens up the spaces between the cells of the intestinal lining. That normally occurs, in order for nutrient and other molecules to get in and out of the intestine. However, when leaky gut is present, the spaces between the cells open up too much allowing larger protein molecules to get into the bloodstream where an immunologic reaction can take place. Once that happens, the body is primed to react to those proteins each and every time they appear.  It can also cause leakage of intestinal contents, like bacteria into the immune system creating inflammation and overloading the liver's ability to filter out this garbage.


Triggers that open the zonulin doorway

Based on Dr. Fasano's research, we know that the two most powerful triggers to open the zonulin door are gluten and gut bacteria in the small intestine.  Gliadin causes zonulin levels to increase both in those people who have celiac disease and those who do not.  As the zonulin level rises, the seal  between the intestinal cells diminishes, opening up spaces between cells that allow all sorts of things to pass right through.  This is called "leaky gut".  Its as if the security guard that keeps the bad guys out is taking a nap! Sometimes large food molecules will pass through to the immune system.  The immune system thinks they are foreign invaders and will mount an immune response leading to food sensitivities.  In addition this immune activation leads to more damage to the intestinal cells (called enterocytes) and the gut becomes more inflamed and more permeable or "leaky".  As the damage continues, the microvilli that line the intestines and absorb nutrients become damaged, leading to other nutrient deficiencies.  

Top causes of increased zonulin and development of leaky gut:

  1. Overgrowth of harmful organisms, like bacteria or yeast in the intestine 
    1. SIBO = small intestinal bacterial overgrowth
    2. Fungal dysbiosis or candida overgrowth
    3. Parasite infections
  2. Gliadin in the diet (gluten containing foods)
Gliadin is a protein in wheat, that like gluten, is a trigger for people with celiac disease. However, a study published in the Scandiavian Journal of Gastroenterology in 2006 clearly showed that gliadin can affect zonulin even in people without the gene for celiac. The researchers concluded that
Based on our results, we concluded that gliadin activates zonulin signaling irrespective of the genetic expression of autoimmunity, leading to increased intestinal permeability to macromolecules.
The significance of this is that gluten affects intestinal permeability in all persons to different extents.  It also means that 100% of patients with autoimmune disease or leaky gut could potentially benefit from a gluten-free diet.

Elevated zonulin levels and leaky gut are also associated with the following:

  1. Crohn's disease
  2. Type 1 Diabetes
  3. Multiple Sclerosis
  4. Asthma
  5. Glioma
  6. Inflammatory Bowel Disease
In conclusion the article states: 
Genetic predisposition, miscommunication between innate and adaptive immunity, exposure to environmental triggers, and loss of intestinal barrier function secondary to the activation of the zonulin pathway by food-derived environmental triggers or changes in gut microbiota all seem to be key ingredients involved in the pathogenesis of inflammation, autoimmunity, and cancer. This new theory implies that [once this path is activated] it can be... reversed by preventing the continuous interplay between genes and the environment.

Zonulin and Its Regulation of Intestinal Barrier Function: The Biological Door to Inflammation, Autoimmunity, and Cancer


Alessio Fasano

Abstract:
The primary functions of the gastrointestinal tract have traditionally been perceived to be limited to the digestion and absorption of nutrients and to electrolytes and water homeostasis. A more attentive analysis of the anatomic and functional arrangement of the gastrointestinal tract, however, suggests that another extremely important function of this organ is its ability to regulate the trafficking of macromolecules between the environment and the host through a barrier mechanism. Together with the gut-associated lymphoid tissue and the neuroendocrine network, the intestinal epithelial barrier, with its intercellular tight junctions, controls the equilibrium between tolerance and immunity to non-self antigens. Zonulin is the only physiological modulator of intercellular tight junctions described so far that is involved in trafficking of macromolecules and, therefore, in tolerance/immune response balance. When the finely tuned zonulin pathway is deregulated in genetically susceptible individuals, both intestinal and extraintestinal autoimmune, inflammatory, and neoplastic disorders can occur. This new paradigm subverts traditional theories underlying the development of these diseases and suggests that these processes can be arrested if the interplay between genes and environmental triggers is prevented by reestablishing the zonulin-dependent intestinal barrier function. This review is timely given the increased interest in the role of a “leaky gut” in the pathogenesis of several pathological conditions targeting both the intestine and extraintestinal organs.

02 March 2013

The Gut Immune System Connection - An Animated Video

The gut mucosa connects with the largest population of immune cells in the body!  Is it any wonder that in functional medicine we assess your gut function as one of the initial steps in cases of allergies, asthma, autoimmune disease, eczema, crohn's disease, ulcerative colitis, IBS, celiac disease, arthritis and more?  

It’s often the first point of exposure to pathogens.   Many microbes use it as a entry point into the rest of the body. The gut immune system therefore needs to be ready to respond to pathogens but at the same time it is constantly exposed to harmless environmental antigens, food particles and commensal microflora which need to be tolerated. Misdirected immune responses to harmless antigens are the underlying cause of food allergies and debilitating conditions such as inflammatory bowel disease. This animation introduces the key cells and molecular players involved in gut immune connection and disease.



By checking your gut's microbial environment and taking a functional medicine approach to health and wellness, we can actually modulate some of the underlying immune dysregulation and eliminate your symptoms!

Nature Immunology homepage: http://www.nature.com/ni/index.html

10 February 2013

A Quick Start Guide To Paleo Diet...

You may have heard the recent buzz about Paleo Diet... so what's all the fuss about?

There are far reaching health benefits to eating more like our grandparents would have eaten...   That means real food, not the packaged processed stuff that has become norm in the Standard American Diet, or SAD for short.

The Paleo Diet may be beneficial in reducing your risk of chronic diseases such as diabetes, obesity, heart disease and many autoimmune and inflammatory conditions.   I frequently use the principles of the paleo diet to help patients re-learn how to eat healthy, maintain ideal weight, and feel fabulous!


You shouldn't be surprised to find a lack of packaged foods on the Paleo Diet menu. There were no convenience stores or super-sized grocery chains in the Stone Age.   And if you're one of the 31% of Americans who eats more packaged foods than fresh foods in your daily diet, it could be an adjustment.  What is amazing, however, are the profound benefits to your health that come from these changes.  If you suffer obesity, heart disease, high cholesterol, central weight gain, or autoimmune disease, like Hashimoto's thyroiditis, Crohn's disease, rheumatoid arthritis, or multiple sclerosis, you greatly benefit from eliminated all processed grains & sugar from your diet.  Plus you will not be eating two of the most common food allergens: gluten and dairy.  If you suffer from a leaky gut or gastrointestinal dysbiosis, the Paleo Diet will naturally restore the healthy microbial balance since there are no refined sugars or grains to feed the abnormal bacteria or yeast.





The Paleo Diet is basically this:  No sugar, No flours, No processed foods, No grains, no legumes (lectins), no dairy.  What you CAN eat is lean, clean (organic) unprocessed meats (chicken, fish, turkey, beef, bison, elk, lamb, etc), all fruits and veggies in moderation.  And coconut, nuts & seeds are to be eaten freely in unprocessed state.  If you need to make something special, almond or coconut "flour" can be used.

CORE PALEO DIET:
  • Meat - GRASS-FED, not grain-fed. Grain causes the same problem in animals as they do in humans.  (bison, elk, buffalo are WONDERFUL red meats to incorporate)
  • Fowl - Chicken, duck, hen, turkey…things with wings that (try to) fly.
  • Fish - Wild caught fish (mercury and other toxins, like PCBs may be an issue in farmed fish)
  • Eggs - Look for Omega-3 enriched eggs raised without hormones or antibiotics from free-range chickens
  • Vegetables - As long as they’re not deep-fried, eat as many as you want.
  • Oils - Olive oil, coconut oil, avocado oil – think natural.  No soybeans oil or processed oils.
  • Fruits - Have natural sugar, and can be higher in calories, so limit if you’re trying to lose weight.
  • Nuts - High in calories, so they’re good for a snack, but don’t eat bags and bags of them.
  • Tubers - Sweet potatoes and yams.  Higher in calories and carbs, so these are good for right after a workout to replenish your glycogen levels
What's not allowed when following the Paloe diet?
  • Grains (including popular cereal grains such as barley, corn, oats, rice, rye and wheat)
  • Beans or legumes
  • Dairy products
  • Refined salt
  • Refined sugars or artificial sweetners
  • Refined fats
  • Canned or processed meats
  • Soda and fruit juices
  • All chemicals, additives, artificial flavorings, MSG, yeast.
Perhaps the most important thing about Paleo is it encourages you to get back to whole delicious real food!  It will allow you to feel better, lose weight easily and maintain muscle at any age.  I challenge you to give it a try for yourself for 30 days and see if it doesn't change your life!


More Resources for Paleo Diet:

http://paleophysiciansnetwork.com
http://www.marksdailyapple.com
http://www.westonaprice.org/

03 January 2013

Healthy Gut = Healthy You!

There is a microbial zoo living inside you, literally trillions of microscopic organisms―more than 10,000 different kinds of them―all co-existing with each other and you.

In fact they outnumber you ten to one and ninety percent of the genetic material, (DNA and RNA) in your body is not yours, it belongs to the bacteria that is located mostly in your gut, but some also live on your skin and even in your nose.

Exactly what those different life forms do has been the subject of some exciting research in recent years, and while a few of these organisms can sometimes wreak havoc with your system, the majority of these little "bugs" are good, helping you digest your food, stay protected from infections, and even keeping your immune system properly regulated to fend off autoimmune diseases like asthma, allergies, and diabetes.

The community of microbes living on and in your body is unique to you – like your fingerprints – and is now being regarded as a key contributor to your overall health.

More and more, science is finding that teeny tiny creatures living in your gut are there for a definite purpose. Known as your microbiome, about 100 trillion of these cells populate your body, particularly your intestines and other parts of your digestive system.

Although some of these bacteria can make you sick, the majority are good, and they work together as to aid your digestive system and keep you well. Beneficial bacteria, better known as probiotics, along with a host of other microorganisms, are so crucial to your health that researchers have compared them to "a newly recognized organ." We now know that your microflora influence your:
  • Immune system function
  • Brain development, mental health, and memory
  • Obesity
  • Genetic expression 
  • Risk of diseases, including autoimmune disease, cancer, diabetes, and autism
According to the featured article in Time Magazine:
"Our surprisingly complex internal ecology has been a hot topic in medicine lately. Initiatives such as the Human Microbiome Project, an extension of the Human Genome Project, have been working tirelessly to probe potential links between the human microbiota and human health, and to construct strategies for manipulating the bacteria so that they work with us rather than against us.

...They've been linked to a range of nasty conditions, including obesity, arthritis, and high cholesterol. Now, two newer areas of research are pushing the field even further, looking at the possible gut bug link to a pair of very different conditions: autism and irritable bowel disease."
Most people, including many physicians, do not realize that 80 percent of your immune system is located in your digestive tract, making a healthy gut a major focal point in your efforts to achieve optimal health. In fact, the root of many health problems is related to an imbalance of intestinal bacteria.  

The beneficial bacteria in your gut has actually been found to help prevent allergies by training your immune system to distinguish between pathogens and non-harmful antigens and respond appropriately – and this may be one reason why they also appear so beneficial in conditions like allergies, asthma, and eczema

 Like it or not, the bugs in your gut have a lot to say about your health!  This is why I frequently test patients gut function for common complaints such as fatigue, migraines, mood disorders, depression, anxiety or insomnia, ecezma, allergies, asthma, autism, and even trouble with concentration & memory.  Getting the gut bugs back into proper balance is critical to your overall health and especially the health of your immune system.  The simplest way to jump start your overall health is pay attention to the gut...  Eliminate sugar and refined flours from your diet and add a high dose probiotic to you regimen.  You'll be well on your way to a happy and helpful intestinal "zoo"!

http://www.health.harvard.edu/healthbeat/the-gut-brain-connection
http://www.mercola.com/
http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/dna-stool-analysis-gi-effects
https://wsunews.wsu.edu/pages/publications.asp?Action=Detail&PublicationID=32253&TypeID=1

17 November 2012

Tips for Dealing with Herxheimer or Die-off Reactions


Photo courtesy of www.freedigitalphotos.com


Dealing With Yeast Die-Off (Herxheimer) Reactions
  
Yeast overgrowth can happen in response to improper diet, poor immunity, difficulties in digestion and antibiotic use. Poorly digested food can lead to putrefaction (rotting) and encourages the growth of organisms.  Antibiotic use destroys the normal balance of gut flora and leaves an open field for bad bacteria and fungi to move in.  Hormones and steroids can make this condition worse, too.  Most importantly, over-consumption of simple sugars & refined carbohydrates will feed the yeast.  If the immune system is weakened or there are not enough probiotic ("good" bacteria) to combat the yeast, then it begins to grow unchecked and cause symptoms, such as "leaky gut".

In this blog, I am addressing specific patients who are being treated for fungal dysbiosis (yeast overgrowth), who may experience a worsening of their condition after starting a program for yeast control. This may be very unsettling & discouraging if it is not understood.  It must be addressed effectively in order to avoid worsening symptoms. Here are some strategies to minimize the chances of suffering unnecessarily from a Herxheimer (die-off) reaction.

Common Symptoms of yeast die-off include:

Fatigue, brain fog, gastrointestinal distress such as nausea, gas, bloating, diarrhea or constipation, low grade fever, headache, sore throat, body itch, muscle and joint soreness or pain, flu-like symptoms. Other symptoms include: lethargy, intense sweet cravings, rashes, irritability, joint stuffiness, or muscle pain. In susceptible individuals with pre-existing neurological symptoms such as hyperactivity, irritability, tantrums, and difficulty concentrating, their symptoms may temporarily intensify.

Yeast die-off reactions are not necessarily a sign that yeast treatment is succeeding. It may be an indication that yeast cells are dying in large numbers, and an indicator of the body's toxic overload. At that point, more poisons are being released than the body can adequately cope with at one time and may be a sign the system's elimination pathways (liver, kidneys, & bowels) are overburdened or blocked (as in constipation or liver congestion)

If properly undertaken, treatment for yeast related health problems should not lead to severe yeast die-off reactions.  Patients with elevated heavy metal levels may more problems with “die-off” symptoms

Strategies to minimize discomfort & shorten duration of die-off reactions

·       Reduce the dose of anti-fungals: Some patients may have to stop altogether for a few days. Dr Jill will generally start doses slowly and increasing them over time to help you deal with the possible die-off symptoms
·       Enzymes: Adding enzymes with meals may improve the digestion of foods and limit putrefactive short chain fatty acids with enzymes.  Use pancreatic enzymes, NOT fungal or plant based enzymes.
·       Stay hydrated:  Dr Jill recommend 4-6 fluid ounces of warm water every forty-five minutes, throughout the day.  Mineral water may help, too!
·       Get your sleep:  It is imperative to rest when experiencing yeast die-off reactions – 8-10 hours per night is essential.
·       Neutralize toxins:  There are ways to neutralize fungal toxins. Dr. Jill may recommend molybdenum, biotin, pantethine or liver support to accomplish this.  Activated charcoal may also help.
·       Alkalinize:  You may buffer the toxins by taking alkalizing agents immediately upon experiencing die-off symptoms. Such products as AlkaSeltzer Gold. Drinking mineral water may also help.
·       Antioxidants:  Provide extra antioxidants to quench the oxidative reactions created by the toxins.  Dr Jilll may prescribe vitamin C, Vitamin E or A, alpha lipoic acid or N-acetylcysteine.
·       Sauna & baths:  If you have access to a sauna, begin slowly (15 minutes per session) scrub all skin surfaces with a stiff brush and shower immediately afterwards. Another helpful detox regimen is Epsom salt baths – use 3-4 cups in hot bath and soak for 20min every night.
·       Keep your bowels moving:  You must address any issues with bowel elimination if you have constipation – if you are not eliminating, you will reabsorb any die-off toxins being released! 

More remedies for constipation:
·       Use magnesium citrate 500-1000mg daily or until normal, soft bowel movements 1 or more X daily.  You may also add Ascorbic Acid 5-10grams daily to bowel tolerance.
·       Start every morning with a tall glass of warm water.  8 oz of coffee may also be helpful.
·       Try a few tablespoons of extra virgin olive oil, several times daily on an empty stomach.
·       Mix 2 TBSP of ground flax or chia seed into water & stir , let sit for 10minutes, stir & drink on an empty stomach.


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15 September 2012

Is Leaky Gut Causing Your Eczema or Psoriasis?


How Leaky Gut is linked to Skin Conditions, like Eczema & Psoriasis...

First a little background ... When the body doesn’t tolerate a food or has created antibodies to that food, ingesting it creates a chronic, low-level irritation or inflammation in the gut. Over time, with regular exposure, the irritation worsens and creates spaces between the cells. (Picture the walls of the gut, once tightly knitted together, looking more like swiss cheese!)   This is what is commonly known as, Leaky Gut.  These holes allow bacteria and their toxins, as well as incompletely digested proteins and fats, to “leak” out of the gut and into the bloodstream. Leaky gut syndrome (or increased intestinal permeability), sets the stage for myriad health problems, including rashes and skin problems, like eczema and psoriasis.  The skin is the body’s largest elimination organ so it’s not surprising that it comes under assault when toxins careen through the bloodstream.   A skin rash or eczema is a sign that the body is trying to slough out these toxins.  Some people will also experience increase in acne or be told they have "rosacea".   The body is trying to eliminate the problem the best way it knows how, and unfortunately you may see the nasty effects of leaky gut manifest in skin problems.  In addition, you might also experience gas, bloating, fatigue, sinus congestion, or foggy thinking.  Many other autoimmune conditions are also linked to the underlying problem of leaky gut.

An Elimination Diet Can Heal Your Skin Conditions

An elimination diet is the best way to pinpoint the offending food.   Here's some practical tips and recipes on how to get started.

Don’t know where to start? Foods that are most likely to wreak havoc on the gut include wheat and gluten, dairy products, sugar, soy, eggs, corn and yeast. If you’re highly motivated go off “the big five” for at least 3 weeks: wheat, dairy, sugar, caffeine and alcohol.

Although this isn't easy, you're guaranteed to notice the foods you are reacting to and 90% of patients feel dramatically better after a 3 week elimination plan. You might also consider keeping a food journal. Spend a week or two writing down what you eat and how your body feels in the minutes, hours and days afterward (e.g., an hour after you eat dairy, you feel bloated). It’s about pattern and symptom recognition and connecting the dots which in turn helps you decide which foods to eliminate first.

If you are a "show-me the data" type of person, there are labs that will test the blood for levels of IgG4 against certain foods and may be a predictor of what foods you are the most sensitive to.  In addition, if you have many reactions to a variety of foods, this is almost diagnostic for leaky gut syndrome and you should consult with a functional medicine doctor to start the healing process.




08 September 2012

Low SIgA and why it matters to your gut health!


What is SIgA?

IgA is a type of antibody that protects against infections of the mucous membranes lining the mouth, airways, and digestive tract... it is your first line of defense on the mucosal lining and it makes up a majority of your entire immune system.

Some people have a genetic deficiency and present with low levels of SIgA and frequent infections.  Others acquire a low level after their intestinal tract becomes over-run with abnormal microbes.

SIgA helps to shape the composition of the microbes in your gut!

Extraordinary amounts of immunoglobulin A (IgA) are produced in your intestinal mucosa daily, it is known as SIgA and is secreted into the human gastrointestinal tract. SIgA production is driven largely in response to mucosal antigens (bugs or food) encountered by gut-associated lymphoid tissue (GALT).  It is clear that secretory antibodies are directed against at least two broad classes of antigens. The first is associated with enteric pathogens (the "bad guys" or infections) and their virulence factors, or things that the bugs secrete, like toxins.


The second broad class of antigens recognized by SIgA is associated with the intestinal microbes or commensal microflora (the "good" guys, like probiotics). In experimental animal models commensal bacteria are potent inducers of secretory antibodies; in humans, it is estimated that between 25 and 75% of intestinal bacteria are coated with SIgA.  This could explain why one of the most basic ways to improve levels of SIgA is to give a patient probiotics and saccromyces boulardii. 


There is also evidence from mice that secretory antibodies play an important role in shaping the composition of the intestinal microbiota, which in turn can influence your gut's defense against invaders and enhance resistance to the intestinal infections.

  
Profound Role in Intestinal Balance and Your Health

So because SIgA can neutralize the "bad guys" and shape the "good guys" SIgA plays a profound role in intestinal balance and health.  SIgA is the main immunoglobulin in mucus secretions. The intestinal cells produce about 2-3grams of SIgA every day!  And production tends to peak in childhood and start to decline after about sixty years old.

This is our first-line defense against gut pathogens like bacteria, food proteins, parasites, fungi, toxins and viruses. SIgA antibodies prevent micro-organisms, food proteins and cancer-causing substances from binding to the surface of absorptive cells. Effectively, they attach themselves to invading bugs and trap them in mucus to prevent them from going anywhere!

The antibodies also 'tag' foods as acceptable to the body and this suggests why low SIgA levels can be a factor in developing and progressive food allergy and intolerance. Intestinal permeability is also related since, if levels are low, repair of mucosal tissues can be compromised.  This is often referred to as Leaky Gut and can coexsist with low levels of SIgA.


Certain SIgA antibodies have been shown to directly quench bacterial virulence, whereas others help with uptake of SIgA–immune complexes by mucosal dendritic cells and result in down regulation of pro-inflammatory responses normally associated with pathogens and allergic antigens.

In fact it is becoming increasingly evident that human health is inextricably linked to the gut microbiota, intestinal homeostasis, and mucosal immunity. IgA is at the centre of this dynamic. 


Testing your SIgA

Secretory IgA is quite independent of blood IgA levels so just because one is normal, doesn’t mean the other is.   SIgA can be measured in different ways, including stool and saliva. Levels can turn out to be low or high. Stool measurements have traditionally been based on sample extractions from animal models – it is hard to ask a mouse to spit! Salivary samples provide a systemic overview of circulating SIgA.

Ongoing low levels can help to explain why people can’t shift an immune problem like allergies, chronic skin conditions or infections. It can also explain why they find it hard to get rid of a microbial infection, too. Celiacs and those with IBD can have low levels and chronic stress has a major effect on SIgA levels. Certain medications can lower levels – including anti-inflammatories.   Other factors  includeviral infections (like Epstein Barr viruses), poor nutritional status, food allergies, ongoing stress. Interestingly some studies have shown variations in levels with gender and age – male patients often have lower levels.


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20 April 2012

Part II - Diagnosis and Treatment of Leaky Gut...

So now you've read all about leaky gut and may be wondering if you have it...

Food allergies, toxins, sugar, antibiotics, parasites and stress can wreak havoc with your gastrointestinal system, upsetting the balance in your intestine as well as allowing harmful substances
to enter the system. Gas, bloating, diarrhea, constipation or abdominal discomfort may be the first clue that something is wrong with the digestive tract, but did you know allergies
or even lack of energy and fatigue can often be traced to digestive problems as well?

Normally the gastrointestinal epithelium provides a semi-permeable barrier with allows nutrients to be absorbed while preventing larger molecules from crossing into the bloodstream.   When this lining becomes inflamed or damaged, then the barrier becomes "leaky".  The fallout results in larger, undigested food molecules and other “bad stuff” (yeast, toxins, and all other forms of waste) that your body normally doesn’t allow through, to flow freely into your bloodstream.

Common causes of increased intestinal hyperpermeability or "leaky gut":
  1. Medications (NSAIDS) like ibuprofen and motrin
  2. Microbial overgrowth or infection
  3. Parasite infection
  4. Fungal overgrowth (Candida)
  5. Ingestion of allergenic foods
  6. Maldigestion/malabsorption (pancreatic insufficieny or low HCl)
  7. Radiation therapy or chemotherapy
  8. Stress
  9. Aging
  10. IgA deficiency
  11. Chronic alcohol intake
  12. Excessive or strenuous exercise
  13. Inflammatory bowel disease - Crohn's or Ulcerative colitis
The small and large intestines contains numerous dietary and bacterial products with toxic properties. These include v bacteria, bacterial cell wall particles, peptides, and bacterial antigens capable of inducing antibodies which may cross-react with human tissues.... when these antibodies react, they may form systemic immune complexes which can circulate and deposit in tissues far away from the gut.

Abnormalities of the gut lining barrier lead to increased uptake of inflammatory molecules and pathogenic bacteria. With inflammation & injury to the gut lininng, mucosal absorption of normally-excluded substances increases dramatically.  Intestinal inflammation enhances the uptake and distribution of potentially injurious bacteria and proteins .


"Leaky Gut" is seen in disorders such as:
  • Inflammatory bowel disease (Crohn's & Colitis)
  • Inflammatory joint disease
  • Food allergy
  • Celiac disease
  • Rheumatoid arthritis 
  • Ankylosing spondylitis
  • Reiter’s syndrome
  • Eczema & psoriasis
  • Bipolar, depression and schizophrenia
  • Allergies and asthma
  • Autoimmune thyroiditis
  • Multiple sclerosis
  • Autoimmune liver & gallbladder disease

So how do we test for "Leaky Gut"?

Small molecules (glucose or mannitol) readily penetrate cells and passively diffuse through them. Larger molecules such as lactulose are  normally are normally not able to diffuse through the cell.  If the tight junctions between the cells are functioning properly, they will prevent the lactulose from leaking through.  The  Intestinal Permeability Test directly measures the ability these two sugar molecules—mannitol and lactulose—to permeate the intestinal mucosa.

Mannitol is readily absorbed and serves as a marker of transcellular uptake.   Lactulose is only slightly absorbed and serves as a marker for mucosal integrity (ability of those "tight junctions" to keep out the bad stuff)  The test is a 6 hour urine test that compares ratios of the two substances.

For more info:

Genova Diagnostics Intestinal Permeability Assessment
You will need to contact your functional medicine physician in order to order the test.


Now for some treatment options for this leaky gut!

Nutritional Support
  1. Glutamine, an amino acid, has been shown to reverse intestinal mucosal damage from various insults. Glutamine is the principle fuel used by the upper intestinal tract to repair and heal.
  2. Agents that stimulate protective mucus secretion may also help with the healing.  Some common ones I use are marshmallow root extract and deglycyrrhizinated licorice (DGL) extract.  
  3. Probiotics are essential!  Lactobacillus casei, bifidobacter species, and saccromyces boulardii, a beneficial type of yeast are all important to restore gut health.
  4. Fish oil can be very helpful in the treatment of intestinal inflammation by decreasing inflammatory prostaglandins.  EPA and DHA should be used in the range of 2-4gm daily
  5. Quercetin functions as a natural mast cell stabilizer and decrease release of histmine which contributes to inflammation & injury.  To be effective, quercetin should be used in powder form and taken 3-6gm daily.
  6. Vitamins A and D are critical to supporting secretory IgA function and restoring the mucosal immune system.  Ask your doctor for specific doses...

To Decrease Toxic Load:
  1. Eliminate all known foods that you are sensitive to.  This can be determined through a comprehensive elimination diet or IgG/IgE food tests on the blood.
  2. Avoid alcohol, NSAIDS (ibuprofen, motrin, alleve), and minimize other OTC medications.
  3. Bentonite clay, a colloidal aluminum silicate, is a well-known intestinal adsorbent
    which absorbs numerous toxins, endotoxins and bacteria.  Its value in permeability alterations may result from lowering the toxin load in the lumen, thus facilitating repair.
  4. HCI and digestive enzymes such as plant enzymes, pepsin and pancreatin might help to lessen the antigenic load or toxic molecules being presented on the intestinal lining.
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01 April 2012

Leaky Gut - The Syndrome Linked to Many Autoimmune Diseases...


"Leaky Gut" Syndrome

Hyperpermeability or "leaky gut" syndrome is the name given to a very common disorder in which the cells lining the intestines become "leaky" due to inflammation. The abnormally large spaces present between the cells of the gut wall allow the entry of toxic material into the bloodstream that would normally be eliminated.

The gut becomes leaky in the sense that bacteria, fungi, parasites, undigested protein, fat and toxic waste normally not absorbed into the bloodstream in the healthy state, pass through a damaged, hyperpermeable gut membrane. This can be verified by special gut permeability urine tests or microscopic examination of the lining of the intestinal wall.


Common Causes of Leaky Gut


  • Infections - fungal overgrowth, parasitic infections
  • Drugs like
  • NSAIDS, chemotherapeutic agents
  • Crohn's disease or Ulcerative Colitis
  • Celiac disease
  • Chronic alcoholism
  • Strenuous exercise
  • Food allergies

Leaky Gut and the Connection to Autoimmune Disease

Leaky gut syndrome is almost always associated with autoimmune disease. In fact, reversing symptoms of autoimmune disease depends on healing the lining of the gastrointestinal tract. Any other treatment is just symptom suppression. An autoimmune disease is defined as one in which the immune system makes antibodies against its own tissues. Diseases in this category include lupus, alopecia areata, rheumatoid arthritis, polymyalgia rheumatica, multiple sclerosis, fibromyalgia, chronic fatigue syndrome, Sjogren’s syndrome (dry eyes & dry mouth), vitiligo, thyroiditis, vasculitis, Crohn’s disease, ulcerative colitis, urticaria (hives), type 1 diabetes and Raynaud’s syndrome. Fortunately doctors are beginning to realize the essential role that the gut plays in these disease. Understanding the leaky gut phenomenon helps us see why allergies and autoimmune diseases develop and how to design therapies to restore intestinal integrity and reverse leaky gut.

Inflammation is a key trigger for leaky gut
Inflammation causes the spaces between the cells of the gut wall to become larger than usua. Then protein molecules are absorbed before they have a chance to be completely broken down. The immune system starts making antibodies against these larger molecules because it recognizes them as foreign, invading substances. Antibodies are made against these proteins derived from previously harmless foods. The immune system becomes hyperstimulated and over-reactive to substances that are not necessarily supposed to be dangerous.

Human tissues have proteins & antigens very similar to those on foods, bacteria, parasites, candida or fungi. The antibodies created by the leaky gut phenomenon against these antigens can get into various tissues and trigger an inflammatory reaction in that tissue when the corresponding food is consumed or the microbe is encountered. Autoantibodies are thus created and inflammation becomes chronic. If this inflammation occurs in a joint, autoimmune arthritis (rheumatoid arthritis) develops. If it occurs in the brain, myalgic encephalomyelitis (chronic fatigue syndrome) may be the result. If it occurs in the blood vessels, vasculitis (inflammation of the blood vessels) is the resulting autoimmune problem... and so on.

If the antibodies end up attacking the lining of the gut itself, the result may be colitis or Crohn’s disease. If it occurs in the lungs, asthma is triggered on a delayed basis every time the individual consumes the food which triggered the production of the antibodies in the first place. It is easy to see that practically any organ or body tissue can become affected by food allergies created by the leaky gut. Because the foods can trigger delayed reactions, it can often be very hard to pinpoint the triggering entity.

 

Leaky gut may cause increase risk of infection and sensitivity to environmental chemicals
This ongoing inflammation also damages the protective coating of antibodies normally present in a healthy gut called IgA. Since IgA helps us ward off infections we become less resistant to viruses, bacteria, parasites and candida. These microbes are then able to invade the bloodstream and colonize almost any body tissue or organ. In the clinic we often find patients with leaky gut or autoimmune disease also have microbial infections ongoing in the gut.

Not only can leaky gut create food allergies as the proteins we consume are activating antibodies, but the microbes in the gut can cross over into the blood stream creating a toxic burden that overwhelms the liver's ability to detoxify. Often in severe cases of leaky gut, patients will develop sensitivities to perfume, cigarette smoke or other environmental chemicals. Common complaints are also "brain fog", confusion, poor focus/concentration, or memory loss.

Leaky gut also causes malabsorption and nutritional deficiencies

Finally, leaky gut may contribute to a long list of mineral deficiencies because of the ongoing inflammation and damage to carrier proteins. The most common are iron deficiency, vitamin B12 deficiency, magnesium deficiency which can lead to fatigue, neuropathies or muscle pain. Zinc deficiency due to malabsorption can result in hair loss or baldness as occurs in alopecia areata. Copper deficiency can occur in an identical way leading to high blood cholesterol levels and osteoarthritis. Further, bone problems develop as a result of the malabsorption of calcium, boron, silicon and manganese.


Part II - Diagnosis and Treatment of Leaky Gut...


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06 February 2012

Stewed Apples with cinnamon - Healing Recipe for a Healthy Gut

 

Stewed Healing Apples and Immune Cofactors

Foods confer information to humans through the direct delivery of micro and macronutrients via different signalling mechanisms. The immune system in the gastrointestinal system is a highly active component of human health and its bacterial load, in conjunction with the foods selected confer a wide range of opportunities for the delivery of information to down-regulate inflammation and heal the gut
 
Functional digestive tract conditions reflect a change in the relationship between the host "microbes" and the mucosal immune and nervous system. These result in a wide range of distressing symptoms for which there are a variety of strategies, but no single intervention of consistent benefit.  However, food choices and types can dramatically affect the gut microbes and encourage healing.  
 
This immune modulating food combination may be eaten for breakfast and dinner or as a meal substitute (no more than 1 substitution per day for many days) and as a quick and soothing snack.

Recipe:

Ingredients for primary stage

  • 6 Rome or Granny Smith cooking apples (or apples of choice preferably grown organically)
  • 1/2 cup water
  • 1/2 cup raisins/sultanas (for added sweetness and fibre)
  • 2 tsp. cinnamon

Directions

Peel and core the apples and chop them into small evenly sized pieces.
Put all the ingredients in a covered, heavy-bottomed pan and cook for about 15 minutes, stirring regularly. Cook until soft with rough shapes, no longer identifiable as apple slices. The colour should be a russet brown with the cinnamon effect.
These may be eaten warm, or cold. I suggest making up as many ramekins (sized to hold 1 – 1.5 apple equivalent in each and covered and put in the fridge for easy access.

Ingredients for secondary stage

  • 1 tsp. of larch arabinogalactans stirred into the apple
  • 1 Saccharomyces Boulardii 250mg capsule sprinkled on the top – or swallowed separately
  • 1 mix of Bifidobacteria (mixed strains) (500mg) 5billion CFU sprinkled on top – or swallowed separately
  • 1 x LGG sprinkled on top – or swallowed separately
  • ½ container of organic natural yogurt or soy equivalent
  • Add 6-8 blueberries and 4-5 almonds in their skins
  • Finally, if required, a teaspoon of Manuka honey

http://www.nleducation.co.uk