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IACA 2013
Keith R. Holden, M.D. • Internal Medicine • Functional Medicine • European Biological Medicine
Special Interests: • Frequency-Based Medicine • Mind-Body Medicine
Member of The Institute for Functional Medicine
IACA 2013
Gut Inflammation & Systemic Disease
• Total surface area (SA) of GI tract > 200X SA skin • GALT contains over 70% of body’s lymphocytes
• Gut immune dysfunction produces excessive inflammation resulting in systemic disease
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Gut Dysfunction & Autoimmune Disease • Genetic predisposition for immune overreaction to triggers
• Trigger (food, microbes)
• Intestinal hyperpermeability - AKA “Leaky gut”
TRIAD in Celiac Disease provides clues for autoimmunity
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Celiac Disease (CD) • Gluten/gliadin proteins in wheat, barley & rye trigger
autoimmune destruction of the small intestine
• Affects one in 133 Americans causing malnutrition and the associated side effects of malnutrition
• Having CD increases risk for other autoimmune diseases
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Food Sensitivity • Delayed reaction (72 hrs) • Non-IgE mediated ( IgG, IgM, IgA) • Cytokine release (Mediators of
inflammation)
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Food Intolerance • Non-immune mediated
• Reaction to food toxins and additives(Botulinum toxin, MSG, aspartame, sulfites)
• Absence of digestive enzymes (Lactose and fructose intolerance)
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Non-Celiac Gluten Sensitivity
• Emerging as a separate condition from Celiac Disease
• Both respond to a gluten free diet
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Gluten and Irritable Bowel Syndrome
• Double-blind randomized placebo controlled trial with Irritable Bowel Syndrome patients (no Celiac Disease)
• 68% of patients given gluten reported IBS symptoms not adequately controlled versus 40% given placebo
Biesiekierski JR, Newnham ED, Irving PM, et. al., Am J Gastroenterol. March 2011;106(3)508-14
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Gluten & IBS Study Summary
§ Provides for the first time high-quality evidence that gluten may trigger gut symptoms and fatigue in individuals who do not have celiac disease • Stimulates additional research to confirm the effect, mechanisms, and prevalence of this condition
§ Impacts the use of gluten restriction on the management of patients with Irritable Bowel Syndrome
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Non-Celiac Wheat Sensitivity(WS) Chart review of all subjects with IBS-like presentation dx with WS using DBPC challenge from 2001-2011
• 276 patients with WS had a higher frequency of: – Anemia – Weight loss – Self-reported intolerance to wheat – Atopy & food allergy in infancy – Positive serum markers for gluten sensitivity – Histology: Eosinophilic infiltration of duodenum/colon
Carroccio A, Mansueto P, Iacono G, et. al, Am J Gastorenterol, Dec 2012;107(12):1898-906
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Why is Gluten Sensitivity Increasing? • Hybridized wheat has increased gluten content and gluten is a
common food additive
• Toxins and hormones in food supply
• Compromised digestive enzymes
• Increased intestinal inflammation/infection/dysbiosis
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Glycemic Index (GI) of Wheat • Higher GI causes more rapid rise in blood sugar (BS)
• Whole wheat bread GI 72
• Table sugar GI 59
• Snicker’s bar GI 41 • Wheat contains amylopectin A (contributes to rapid BS rise)
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Wheat (High Glycemic Index Food) • Cause a rapid elevation in blood sugar
• Stimulates insulin release (fat storage hormone)
• Accumulation of abdominal fat (VAT), which acts as an active endocrine organ pumping out inflammatory mediators and hormones (estrogen)
• VAT is associated with insulin resistance (T2DM)
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Hybridization of Wheat • Wheat strains hybridized & cross-bread for resistance to
drought and pathogens
• Resulted in changes to genetic code altering protein (gluten/gliadin) structures
• Altered proteins cause abnormal immune response
• Others have immune response to non-gluten components of wheat
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Wheat Withdrawal • 30% of people have withdrawal sxs with elimination
• Studies show adverse affect of wheat on schizophrenics
• Rat study showed gluten + stomach acid produced polypeptides (gluteomorphin) that cross BBB, which is blocked by naltrexone
• Wheat may be an appetite stimulant (cravings)
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Wheat Negatively Impacts Lipids
• Wheat and other high GI carbs increase TG/VLDL
• Sustained elevation in TG can be packaged into VLDL particles, precursors of small LDL particles (higher CV risk)
• Sustained elevations in lipids results in fatty liver, a potential precursor to cirrhosis
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Remove (Stressors) • Address stress including old emotional toxins
• Food sensitivities (Elimination Diet, ALCAT)
• Detoxify external and internal biological toxins
• *Pathogenic microbes (bacteria, yeast, parasites)
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*Priority Testing – CDSA/Parasitology • CDSA – Comprehensive Digestive Stool Analysis
• Assesses levels of beneficial and pathogenic microbes
• Assesses gut inflammatory markers, bile salts, HCL status, and pancreatic enzyme function
• Does not assess for small intestinal bacterial overgrowth
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Repair • Rest • Vitamins (pantothenate, E, A, D, C) • Activated B vitamins • Support of GALT function (lactoferrin, whey, Ig) • Antioxidants (catechins) & minerals (zinc) • Anti-inflammatories (curcumin, EPA/DHA/GLA) • Glutamine and aloe vera
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Reinoculate
• Probiotics (mix of Lactobacillus & Bifidobacter sp.) • Saccharomyces boulardii (C. difficile)
• Prebiotics (Arabinogalactan)
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Rebalance
• Lifestyle changes
• Scheduling rest and relaxation; adequate sleep
• Mindful eating
• Balance ANS (belly-breathing, HeartMath app)
• Balance brain waves (Cranial Electrotherapy Stim.)
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Detailed Orodental Assessment • Plaque (biofilm), amalgams, crowns, bridges
• Malocclusion stresses the ANS
• Old root canals (possible occult infection)
• TMJ (NM Dentist, CST, Chiropractor)
• Tongue, gums, mucous membranes, tonsils
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Summary • Foods can trigger abnormal immune response
• Leaky gut (intestinal hyperpermeability) overwhelms liver detoxification & contributes to excessive inflammation
• Dysfunction of gut immune system creates excessive inflammation resulting in systemic disease (autoimmunity)
• Address the whole person (body/mind/spirit)
• Always address stress in your patients (#1 killer)
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Case Study • 44 y.o. healthy male with sudden onset of severe IBS • Abdominal bloating, diarrhea, weight loss • Moderate reaction to gluten on ALCAT • Stool testing: 1+ Yeast • Colonoscopy: Aphthous ulcers sigmoid colon • Med history: Replacement of 7 silver amalgams one
month prior to the onset of symptoms
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Final Advice • Stay open to possibilities – Question status quo
• See the world through the eyes of a child
• Embrace change
• Take with you what resonates with you and leave the rest alone (what feels right)
• Never stop evolving (transformation/growth)
822 A1A North Ste 310
Ponte Vedra Beach, FL 32082 Ph: (904) 473-4954
krholden@gmail.com
www.Dr-Holden.com
Keith R. Holden, MD
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