BEYOND THE GUT - Ontario Association of Naturopathic Doctors

Transcription

BEYOND THE GUT
Examining the Gut-Brain
Connection in Woman’s Moods,
Health, and Well Being
Dr. Kumar Biswas, BSc (Hons), ND
Doctor of Naturopathic Medicine
1350 England Avenue, Suite 103
Courtenay, BC V9N 8X6
kumar@aquaterrahealth.ca
T. 250.338.2799
Kumar Biswas, BSc (Hons), ND
Education:
• 
BSc (Hons) – Dalhousie University - Halifax, NS
• 
NSERC Research Assistant, Labrador – Mount St.
Vincent University, Halifax, NS
• 
Doctor of Naturopathic Medicine – Canadian College
of Naturopathic Medicine, Toronto, ON
Memberships:
• 
Nova Scotia Association of Naturopathic Doctors
(NSAND)
• 
Board of Directors of Drugless Therapy – Naturopathy
(BDDT-N)
seamless well being™
• 
College of Naturopathic Physicians of British Columbia
(CNPBC)
• 
Canadian Association of Naturopathic Doctors
(CAND)
• 
Institute of Functional Medicine (IFM)
• 
Occidental Institute Research Foundation (OIRF)
www.aquaterrahealth.ca
Outline
•  Gastrointestinal Physiology and the Enteric
Nervous System (ENS)
•  The Matrix and The Microbes
•  Biology and Nutrition
•  Biological Medicine Clinical Assessments
•  Clinical Cases inserted throughout
•  A ‘Gut Feeling’ about the Future
Important Learning Objectives
•  Understanding the functional physiology of the
Gastrointestinal (GI) System as it relates to the
entire “millieu”
•  Understanding the importance of Syn-biotic
Balance
•  Clinical pearls through Case Studies
•  Re-visiting simple, practical in-office assessments
•  Understanding why bowel health is brain health
Principles of
Naturopathic
Medicine
Establish Health and Wellness
Prevention is the Best Cure
Treat the Whole Person
Physician as Teacher
Identify and Treat
the Cause
First do no
Harm
The Healing
Power of
Nature
Hypothesis
The human gastrointestinal tract and it’s
biota are like a second brain and significantly
effect our Mind, Mood, and Behavior.
GI tract acts independent of CNS…
•  1850-60’s Auerbach (myenteric plexus) & Meissner
(submucosal plexus)
•  1899-1900 Bayliss & Starling “law of the intestine”
•  1917 Trendelenburg in vitro peristaltic reflex
•  1921 Langley ENS separate but equal division of the
autonomic nervous system
•  1987 Gottschall books “Food and the Gut Reaction”
& “Breaking the Vicious Cycle”
•  1999 Gershon’s book “The Second Brain”
•  2013 Herbert’s book “Bugs, Bowels, & Behavior”
Gastrointestinal Physiology Facts
•  Largest organ in the human body – 6 meters
long with a surface area of 2000 sq. meters
•  9 Liters of fluid pass through the GI tract daily
– 3.5 L Exocrine Glands/ 3.5 L Epithelial Cells
with 2 L Ingested
•  Numerous Glands: Compound Acinous glands,
Single Cell Mucous Glands, Goblet Cells,
Brunners glands, Crypts of Lieberkuhn
GI Facts Continued…
•  Largest amount of immune tissue in the body
70%= gut associated lymphoid tissue (GALT)
•  Regulated directly by the Enteric Nervous System
(ENS) with feedback and amplification coming
from hormones and cytokines
The Second Brain –
Enteric Nervous System
•  100 Million Neurons (more than the spinal cord
and peripheral nervous system)
•  Devoid of Collagen terminating in enteric glia
•  90% of Primary Visceral Nerve fibers carry
information from the GI tract to the Brain
•  ENS & CNS embryologically similar
•  Every class of CNS neurotransmitter has been
found in the ENS
ENS
•  Microcircuits with great complexity
•  90% of our Serotonin is stored in the
enterochromaffin cells of the ENS
•  50% of Dopamine in GI tract
•  ENS neurons:
a)  Auerbach’s Myenteric Ganglia
b)  Meissner’s Submucosal plexus
Serotonin
•  Mood & Happiness
•  GI Motility & Digestion
•  In platelets as vasoconstrictor regulating
blood clotting
•  Acts as a growth factor in wound healing
Nutrients supporting Serotonin production:
•  B6, Magnesium, Calcium, 5 HTP
Gut-Brain Axis (GBA)
Frontiers in Integrative Neuroscience, 07 Oct. 2013
Immune Connection
•  GALT has innate and humoral response
•  Peyer’s patches, secondary lymphoid
tissue, and lymphoid follicles, tertiary
lymphoid tissue respond to antigenic
stimuli – Matrix connection
•  Regulate to determine self from non-self
whilst interacting with the outside world
•  Cytokines released have a endocrine and
paracrine action from lymphocytes
Vagus Connection
(afferent)
•  Autonomic parasympathetic bidirectional
feedback to the heart and GI tract
•  Neuronal synaptic terminals direct contact
•  Enteroendocrine cells release gut peptides
to signal CNS via Vagus
•  80-90% vagal nerve fibers are afferent
(sensory) nerves, sending viscera
information to the brain
Brain-Gut Feedback Connection
•  Post brain stem relays (tractus solitarii)
show a neural network involving the
amygdala and insular cortex processing
visceral inputs
•  Hypothalamic signaling initiates the
efferent reflex
•  Hypothalamic-pituitary-adrenal (HPA) axis
initiates hormonal GI response
•  Sympathetic activation and antiinflammatory cholinergic reflex
Microbiota Connection
•  Endosymbiot’s evolved feedback channels
with CNS to maintain homeostasis
•  Protect against pathogens
•  Metabolize complex lipids and
polysaccarides that signal GI epithelium
•  Microbiota-Gut-Brain (MGB) axis (Rhee et
al. 2009; Cryan & Dinan, 2012; Forythe et
al., 2012)
GBA Imbalances
•  Anxiety
•  Depression
•  Obesity
•  Pain
•  Autism Spectrum Disorder (ASD)
•  Multiple Sclerosis (MS)
•  Cardiovascular Risk (CVD)
Clinical Case - MA
•  Jan ’14 30 YO Autistic (dx 34mo.) female
cc’s: acne, allergies, amenorrhea, fungal
infection, seizures, indigestion, PCOS,
periodontal dz., & poor hair growth.
•  PE: Bilateral Pupillary Reflex (BPR) <1sec,
tongue thick white coat & dark purple injected
veins ventrally, numerous perioral acne lesions
•  Lab blood results: prolactin, LH, FSH,
progesterone, & testosterone all normal, HbA1c
4.3 LN, Neuts (Auto/#) HN, Lymphs L.
MA: 30 YO Female
cont’d
•  Electrodermal Screening (EDS): microbial fungal
imbalance, LI & SI dysbiosis, remedy test –
probiotics and magnesium
•  Px: lamotrigine 100mg 2.5 bid
•  Rx: omega-3 (yellow cap) 1 tid, probiotic 10 B
‘active’ cells, multivitamin one a day for women 1
qd, vitamin D 1 qd.
•  Allergies: penicillin
•  Reaction to H1N1 vaccine
MA: 30 YO Female
cont’d
•  Assessments: digestive dysfunction, dysbiosis,
fungal imbalance, magnesium deficiency w/
poss. toxic metals, adrenal insufficiency, ASD
•  Plan: contact pharmacist to facilitate MD to
sign off on new probiotic dose and magnesium
•  Isopathic’s for dosing when parents are caring
for MA
•  Order Hair Mineral Analysis (HMA)
MA: 30 YO Female
cont’d
•  Apr ’14: V2 phone consult with parents
•  Update: Supplements OK’d, Gyn. Specialist
Px BCP and GP Px benzoclin topical, acne
•  HMA: following ratios; Ca/Mg high, Zn/Cu
very high, Na/K very low & Na/Mag low.
Plus the presence of Aluminum (Al)
•  Plan: avoid Al containing antiperspirants,
Sea Salt, discuss ceruloplasmin testing &
continue with initial visit Rx’s
MA: 30 YO Female
cont’d
•  Aug.’14: V3 improvement in acne, no seizures
since V2, no menses, accompanied by care
giver who reports MA more emotional
•  EDS: LI & SI dysbiosis persists
•  Px: new Beclomethasone 50 mcg 1 spray bid in
each nostril, Chlorhexidine 0.12% two weeks
on/off, Ethinyl Estradiol & Norgestimate Cyclen
28 (0.25&0.035) qd, Dimenhydrinate 50mg
prn
MA: 30 YO Female
cont’d
•  PE: BPR remains <1sec, tongue moderate
white coat & dk purple veins, decreased
50% perioral acne, sclera N
•  Assessments: : digestive dysfunction,
dysbiosis, fungal imbalance, Al toxicity,
mineral imbalances, Px side effects
•  Plan: talk to parents about medications and
continued dysbiosis & ceruloplasmin
testing logistics, increase probiotics 3 bid
Who’s Running the Show?
•  Our body contains 100 trillion microbes
outnumbering cells: 10 to 1
•  400 GI microbial species – roughly 35
species make up 99% in the GI tract
•  Estimated weight = 2.5-2.7kg
•  Varied life cycles, from single cell to
colonial complexes known as biofilm
Bugs and the Brain
From: Nature Reviews | Neuroscience 13, 701-712 October 2012
Healthy Flora Promote…
•  Digestion of food and absorption of nutrients
•  Protection from pathogenic microorganisms
•  Vitamin production (B’s & K), mineral
absorption
•  Elimination of Toxins and production of
cytochrome P450-like enzymes
•  Anti-mutagenic, Antitumor and
Immunomodulation effects
Probiotic Synergy
From: Brain-Gut-Microbe Communication in Health and Disease, Dec. 7, 2011.
Metabolic Imbalance –
Insulin Resistance Syndrome
•  Insulin Resistance Syndrome is common in
many chronic conditions:
u Heart disease
u Diabetes
u Hypertension
DANGER
INSULIN
RESISTANCE
u Obesity
u Sarcopenia
u Polycystic Ovary
Syndrome (PCOS)
Exercise & Metabolic Balance
•  Muscles use
blood sugar for
fuel
EXERCISE
BLOOD SUGAR
•  Exercise helps
transport blood
sugar into cells,
keeping blood
sugar and insulin
in healthy range
INSULIN
Metabolic
Balance
Alpha Lipoic Acid
•  Important antioxidant
•  Works with vitamin E, C and CoQ10
•  Supports normal glucose use by improving insulin
sensitivity
Alpha Lipoic Acid
Glucose
Metabolism
Bioelectric Impedance Analysis (BIA)
...Measures body composition
•  Lean muscle mass – predicts
BMR
•  Body fat %
•  Body water – hydration status
BIA Assessment
Impedimed
Primary Nutrition and
Metabolic Balance
•  Water
Fat
Water
Protein
•  Protein
•  Essential Fatty Acids
Metabolic
Balance
Water
•  Our bodies are made up of 60% water
•  Water helps flush toxins out of our bodies
•  Water helps transport nutrients and
electrolytes to and from our cells
Water, Protein & Fat
Diagram from:
Staying Healthy with Nutrition, Elson Haas, 1992
Studies Say…
•  ‘Gut Microbiota regulate the set point for
hypothalamic-pituitary-adrenal axis activity’ Neurogastroenterology and Motility March 2011; 23(3);255-319
•  ‘Bifidobacterium longum NCC3001 shown to
help normalize anxiety behavior in Mice with
infectious colitis’ - Neurogastroenterology and Motility December
2011; 23(12); 1132-1139
•  ‘Lactobacillus rhamnosus reduced anxiety and
depression-related behavior’ - Proceedings of the National
Academy of Sciences 2011 Sep 20;108(38):160050-5
Matrix System
•  Dr. Pischinger showed that the cells and organs are
absolutely dependent on the Matrix material that surrounds
them (the humors and fluids).
•  The cell does not exist in a vacuum. It has a very large and
important support structure.
•  Ground substance, Humoral system, Connective tissue, and
Matrix are among the most common names of this tissue.
•  The Matrix System is the basic regulation system of the
entire organism.
Matrix Structure
The matrix (connective tissue) is a
functional system. It has 4 components:
1.  The Cell
2.  Matrix or Ground substance
3.  Neural-Vascular Unit
4.  The membrane receptor
The Matrix
The Extracellular Matrix
•  Extra cellular matrix (ECM) is the
link between cells and the
exterior.
•  ECM provides a frame for cell
movement.
•  ECM is a tri-dimensional complex
of proteins carbohydrates, salts,
fixed cells, migrating cells and
fibers that fully support tissue
and allow the exchange of
information with the environment.
MATRIX SYSTEM ACCORDING TO PISCHINGER www.aquaterrahealth.ca
The Matrix or Ground Substance
•  Sugar
•  Protein complex
•  Proteoglycans
•  Glycosaminoglycans
•  Structural proteins
•  Collagen
•  Elastin
•  Meshing glycoproteins
Structural Proteins
and
Fibroblasts
Adhesive proteins
Lymphatic system
Fibrinolectin
Laminins
Integrins
Microcirculatory
GAGS
Arterial
Capillary
Venous
Chondrotin sulphate
Hyaluronic acid
Migratory Cells
Monocytes
Macrophages
Lymphocytes
Dendritic cells
Mast cells
Neutrophils
Granulocytes
Fixed Cells
Fibroblasts
Adipocytes
Mesenchymal
The Fibroblast
The Fibroblast is the functional cell of the extra-cellular matrix.
•  capillary-like communication
•  spider-like connection of glycosaminoglycans.
Field Activity of the Matrix
•  The field of activity and
information of the Matrix is
the extracellular fluid,
including lymph fluid.
•  The Matrix is a molecular
sieve that filters, nourishes,
defends, repairs, and
supports the cellular
structures.
•  The matrix is the largest
system penetrating the
entire organism. It permeates
the extra cellular space and
reaches every cell.
Matrix Regulation
•  Biological Matrix Regulation therapy is accomplished
using local regulatory therapies in the Ground System
plus neural and biological response modifiers.
•  Techniques such as acupuncture, mesotherapy and
neural therapy improve Matrix Regulation locally and
globally.
•  Homeopathic, Herbal and Orthomolecular methods are
directed at the functions of the Matrix System, such as
hormonal, enzymatic, or oxidation/reduction reactions.
Primary Matrix Functions
•  Nutrition - Defense – Repair.
•  The Matrix is capable of both specific and
non-specific responses to stimuli.
•  Matrix reacts locally and entirely.
•  Matrix reacts more to the strength than to
the type of stimulus.
Regulation Therapy
…is based on the use of therapeutic
techniques that maintain or restore dynamic:
•  Physiochemical
•  Energetic and/or
•  Information flow
within and throughout the matrix system…
The gut-brain connection is
dependent on a healthy matrix system
Matrix Regeneration Therapy
pH Balance
• 
• 
• 
• 
Optimal pH range is 6.8 – 7.2
Food, activity and emotion all affect pH
Acidic terrain upsets mineral balance
The most common obstacle to cure
Why do we get acidic?
•  Excess acidifying foods (meat, sausage, cheese…)
•  Too much stress
•  Inflammatory processes (arthritis, sprains/strains…)
•  Allopathic drugs
•  Not enough alkalinizing food (fruits, vegetables)
•  Lack of exercise and fresh air
Blood Type
•  ABO blood groups evolved from biological
& environmental variables, (i.e. nutrition &
microbes) as well as human adaptations for
survival
•  In-office, objective test to differentiate
between blood type O, A, B, or AB
•  Dr. Peter D’Adamo’s Blood Type Diet is a
useful tool as a nutrition starting point
Electrodermal Screening (EDS)
•  1950’s Dr. Reinhold Voll measured galvonic
skin response – Electroacupuncture according
to Voll (EAV)
•  EDS machines evolved in dozen’s of
companies with various technologies
•  Basic ohm meter for the human body –
measuring the bioelectrical/magnetic systems
as opposed to the more familiar biochemical/
mechanical systems
Electro-magnetic Assessment
•  Electrocardiogram (EKG) and Magnetic
Resonance Imaging (MRI) are assessment tools
measuring bioelectrical and magnetic pulses
interpreted with a mechanistic approach
•  EDS is an assessment tool that provides
information about the health of the body via
electrical measurements (resistance) of the skin
at specific acupuncture points, interpreted with
a holistic approach
Clinical Case - DB
•  Jan’14 48 YO GV 0, appendectomy @ 1YO
•  cc’s: allergies, anxiety, depression, dysmenorrhea,
PTSD, sinusitis and stomach problems.
•  PE: bilateral pupillary reflex fixed, tongue mild
white coat with numerous raised papillae posterior,
4/10 nail ‘moons’, vertical nail ridges, orthostatic
110/70 lying 100/62 standing, spO2 97%, pulse 88
•  Blood Type: O
DB: 48 YO Female cont’d
•  EDS: enzyme deficiency, liver/bile duct
congestion, pro-inflammatory, remedy
tolerance new & previous.
•  Px: Tecta 40mg qd
•  Rx: womens one a day, vitamin D3 400IU,
curcumin, zinc lozenges w/ echinacea, vit c
•  Allergies: X-ray dye
•  Assessments: anxiety, digestive dysfunction,
dysthymia, possible LGS, LV Qi & blood
stagnation
•  Plan: digestive enzyme support, GI protein/
herbal supplement, liver drainage (complex
homeopathy), curcumin 1 bid, vit D 3 tab
qd (rec 1 tab 1000 IU qd), Kali Phos 6X 4
tabs tid, blood type O nutrition
•  Feb ‘14 phone call that Kali Phos caused
worsening of anxiety sx’s
•  Plan: B12 methylcobalamin subliqual & DGL
from HFS, stop Kali phos 1 wk
•  Mar ’14 ST/GI sx’s 80% >, anxiety ‘only’ 50%
>, < w/ diarrhea & am, more aware of
emotional eating, eating to BT O positive
•  PE: bilateral pupillary reflex fixed, OBP 118/65
lying 115/60 standing, spO2 99%, pulse 78
•  EDS: adr med/cortex, remedy tolerance; – Kali
Phos/sulfur, + DGL
•  Assessments: improving GI, adrenal
insufficiency, ME imbalance
•  Plan: finish liver drainage, adrenal glandular
support, complex homeopathy for ME,
continue previous plan
•  Mar ‘14 phone call diarrhea < ? Meds
•  Plan: continue plan, congee water 1/2c qd-qid,
remove all dairy, wheat & switch to organic
eggs
•  Aug ‘14 feels GI symptoms ‘cleared’ and does
not need to take homeopathic for anxiety,
continues with all other Rx’s
•  Lab blood test (June ‘14) results: normal AC
glucose, eGFR, creatinine, lytes, lipids, albumin,
liv enzymes, TSH, estradiol, FSH, prolactin,
CBC with HN LH and ferratin 12ug/L, vit B12
568pmol/L
•  UA normal
•  PE: BPR 1sec, OBP 115/65 lying 118/68
standing, spO2 99%, pulse 68
•  EDS: imp. HPA, LH N, iron-, liquid iron +
•  Assessments: GI balance, improved ME
state, recovering adrenals, low iron stores
•  Plan: add liquid iron 10ml bid 14day then
qd, probiotics 2qd 7 days/mo, flu/cold
prevention, continue prev. Rx’s
GBA
Heart Rate Variability (HRV)
Assessment of the Autonomic Nervous System
QRS Complex
Normal Electrocardiogram (ECG)
x-axis: PSNS
y-axis: SNS
Clinical Case - JC
•  Dec’ 58 YO GV 1, single Mom
•  cc’s: allergies, anxiety, bloating, diarrhea,
exhausted, insomnia, and low libido
•  PE: bilateral pupillary reflex fixed, tongue
thick white coat, 0/10 nail ‘moons’, vertical
nail ridges
•  Blood Type: O
•  HRV: see results
JC: 58 YO Female cont’d
•  EDS: dysbiosis SI & LI, adrenal med/cortex
imbalace, B12 low
•  Rx: vitamin C if has cold
•  Allergies: penicillin
•  Assessments: dysbiosis, adrenal fatigue, and
poor oxygen utilization
•  Plan: vitamin B12 IM shots 1/wk 5 weeks, ozone
intestinal insufflations 2/week, probiotic 40
billion/d, adrenal glandular supplement, and
blood type O nutrition
INITIAL ASSESSMENT
ORTHOTEST
RESULTS
(initial assessment)
PHYSICAL FITNESS LEVEL (initial)
•  Feb ’14 bloating, diarrhea cleared and has
more energy, sleeping better and wants to
be more ‘social’
•  PE: bilateral pupillary reflex 2 sec., tongue
mild white coat, nail moons no change with
less ridging at base
•  HRV: see results
FOLLOW-UP ASSESSMENT
ORTHOTEST
RESULTS
(follow-up assessment)
PHYSICAL FITNESS LEVEL (follow-up)
•  Assessment: improved dysbiosis, adrenal
fatigue and oxygen utilization
•  Plan: switch to oral methylcobalamin qd (+1
prn), probiotics 20 billion/d, adrenal
glandular 2caps am & 1 lunch, work with
blood type O nutrition
•  GBA treatment yields results
Exhaustion
Imbalanced ANS
Vitality
Balanced ANS
Oxygen – A Vital Nutrient
Oxygen Utilization
Causes of
Decreased Oxygen Utilization
Pre-Mitochondrial Factors
Mitochondrial Factors
•  Decreased
Lipolysis
•  Toxicity (especially
Mercury)
•  Hypoglycemia
•  Ischemia
•  Infections
•  Stress
•  Hypoxia
•  Nutritional &
Hormonal deficiencies
•  Inflammation
•  Decreased Methylation
•  Decreased Fitness
Ozone
Ozone Production
Toxicity In The Bowel
•  A Natural Barrier to Toxic Substances
•  “Leaky Gut Syndrome”- passage of toxic substances
into the body
Toxic Load
Exposure to toxic substances
External
• 
Food additives, chemical solvents,
heavy metals pesticides, herbicides,
drugs, alcohol
Internal
• 
Microbial: bacterial, fungal, viral and
parasites
Expressions Of Toxicity
•  Headaches
•  Muscle aches and pains
•  Irritability, mental confusion
•  Allergy or flu-like symptoms
•  Chronic fatigue
•  Depression
•  Joint pain
•  Insomnia
•  Behavioral
‘Gut Feeling’ about the Future
•  The Gut-Brain Axis plays a key physiological role in
the regulation of women’s health
•  The Enteric Nervous System depends on a
balanced matrix system for effective
communication to the brain
•  When the GBA, and the ENS, are dis-regulated,
there is a direct affect on mood and behavior
•  Addressing the human microbiota milleu in
naturopathic medical treatment, will become
integrated in all medicine of the future
Questions?
Thank you for attending

BEYOND THE GUT - Ontario Association of Naturopathic Doctors

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