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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

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Food, Your Gut, and Your Health

Keith R. Holden, M.D.

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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 Associated Lymphoid Tissue (GALT)

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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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Celiac Disease Triad #1

Fasano A. Sci Am. August 2009;301(2):54-61

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Celiac Disease Triad #2

Fasano A. Sci Am. August 2009;301(2):54-61

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Celiac Disease Triad #3

Fasano A. Sci Am. August 2009;301(2):54-61

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Three Types of Reactions to Food

•  Food Allergy •  Food Sensitivity

•  Food Intolerance

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Food Allergy

•  Immediate reaction

•  IgE mediated

•  Histamine release

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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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There is no one test that diagnoses gluten sensitivity in all individuals!

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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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William Davis, M.D. - Cardiologist

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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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Replace •  HCL acid

•  Digestive enzymes

•  Bile salts

•  Fiber

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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