5. GASTROINTESTINAL HEALTH Flashcards

Question

Why is adressing intestinal tight junction permeability important?

Answer 1

Intestinal tight junction disassembly contributes to ↑ LPS load and excessive immune reactions

Answer 2

* Glutamine (cabbage juice, spirulina, asparagus) * Zinc carnosine * Vitamin A * N-Acetyl glucosamine * Bone broth (rich in glycine)

Answer 3

* test for zonulin in stool * Cyrex Labs Array 2 (serum antibodies)

Answer 4

Immunoglobulins residing in the mucosal lining and protects the intestinal epithelium from toxins and pathogenic microbes through a process called immune exclusion (promoting the clearance of antigens by blocking their access to epithelial receptors)

Answer 5

* Ongoing emotional/physical stress * NSAIDs * Antibiotics

Answer 6

* Address stress * Saccharomyces boulardii * Mushrooms (esp. medicinal) * Vitamin A - transports SIgA over the mucosal lining * Vitamin D3 - upregulates SIgA expression * Polyphenols * Chlorella * Probiotics and prebiotics * Echinacea spp

Answer 7

It is a diet where suspected foods are removed for a period of time and changes in symptoms monitored. Then the food is reintroduced and symptoms are monitored again to confirm sensitivity. It is a cost effective way of identifying food allergies or intolerances.

Answer 8

gluten dairy corn and soy eggs nuts beef pork yeast citrus nightshades chocolate coffee

Answer 9

1-2. This is the detox stage.

Answer 10

Days 3-14 (± 12 days). This is the elimination stage. If symptoms don't improve by 3rd week, consider other possible triggers.

Answer 11

Day 15 onwards. This is the reintroduction stage. One food is reintroduced for 1-3 days and any symptoms monitored.

Answer 12

1. Remove 2. Replace 3. Reinoculate 4. Repair 5. Rebalance

Answer 13

What needs to be removed to support healthy GI function? * Dietary irritants * allergens/intolerances * toxins * unnecessary drugs

Answer 14

* berberine * garlic * oregano * uva ursi

Answer 15

oregano oil berberine garlic neem

Answer 16

black walnut hulls wormwood oregano neem clove buds pumpkin seeds

Answer 17

- caprylic acid - grapefruit seed extract - garlic

Answer 18

olive leaf extract nano silver elderberry

Answer 19

Replenish digestive factors that may be lacking: - Stomach acid secretions e.g., digestive bitters, HCI - Pancreatic support e.g., bitters, pancreatic enzymes (PERT) - Bile support e.g., choleretics / cholagogues

Answer 20

- Probiotic foods (cultrued vegetables, fermented foods and drinks) - Probiotic supplements - Prebiotic foods (foods rich in fructans, FOS and inulin)

Answer 21

**Epithelial & tight junction support:** - L-glutamine - N-acetyl glucosamine - quercetin - zinc - EFAs - B vitamins - Vitamin A - collagen - bone broth - aloe vera **Mucous barrrier support:** - mucilage rich demulcent herbs (slippery elm, liquorice, marshmallow root, meadowsweet) - fibre - polyphenols **Increase SIgA and reduce inflammation:** - *S. Boulardii* - Curcumin

Answer 22

- adressing stress - good sleep hygiene - regular exercise

Answer 23

Dysbiosis is an imbalance in the colonies of the bowel flora, leading to a potential disruption in both local and systemic health.

Answer 24

* poor diet (highly processed, high refined carbs, ↓ fibre, ↓ polyphenols) * intestinal/oral infections * medications (antibiotics, antacids, OCP) * chronic stress (= ↓ digestive secretions) * low digestive secretions (HCI, bile) * C-section, non-breastfed * GI suregry and abdominal scar tissue

Answer 25

A combination of hypertension, insulin resistance and obesity.

Answer 26

* Atopic diseases * Metabolic syndrome -Associated with less Bifidobacteria and Akkermansia spp. A diet rich in fibre and SCFA-producing bacteria (probiotics) has shown improvements in metabolic syndrome. * Colorectal Cancer -Fibrous diets ↑ abundance of SCFA-producers and beneficial bacteria. * Neurodegenerative diseases -Alzheimer’s, Parkinson’s and MND

Answer 27

A subclinical rise in bacterial LPS in the blood, resulting in chronic low-grade inflammation.

Answer 28

Dysbiosis, mucosal degradation and permeability of the GI tight junctions (often interlinked).

Answer 29

* CVD * Diabetes Mellitus * Autoimmune diseases * Degenerative disorders

Answer 30

* Avoid alcohol (↑ LPS transport across the intestinal epithelium), other dietary irritants/toxins/NSAIDs * Avoid western or ketogenic diet * Increase dietary fibre (to bind and clear LPS via the bowel and to feed butyrate producing species - Roseburia, Akkermansia spp.) * Focus on the rainbow of colour to feed keystone bacterial species, ↓ inflammation and discourage growth of gram-negative bacteria * Reinoculate and support GI barrier (stage 3 and 4 of 5R) * Support liver function, bile production/flow to aid LPS clearance (milk thistle, burdock root, artichoke, dandelion, spirulina, chlorella) * A variety of dietary antioxidants (E, C, carotenoids, Se) * NAC, cruciferous veg and resveratrol to ↑ glutathione * Nrf2 inducers (to scavenge ROS) - broccoli sprouts, green tea * Breathing techniques and cold exposure reduce systemic LPS load.

Answer 31

An overgrowth of non-pathogenic bacteria in the small intestine. It is the most common cause of IBS (60-70%)

Answer 32

* Bloating * Abdominal pain or discomfort * Constipation/diarrhoea * Flatulence * **All symptoms must be chronic and happen after every meal**

Answer 33

* Worsening GI symptoms from probiotics (try for 3-7 days to be sure) * Fibre worsening GI symptoms * Chronic GI symptoms following long term broad spectrum antibiotics/PPIs/opiates * Chronic low ferritin/iron with no other causes * Developing IBS following GI infection * When a coeliac patient reports insufficient improvement from strict GF diet.

Answer 34

* Hypochlorhydria and bile insufficiency (HCI + bile are anti-microbial) * Low SIgA * Prolonged stress (↓ SIgA and HCI) * Scar tissue adhesions from surgery * Hypothyroidism (slows motility) * Poor oral health * Ileocecal valve dysfunction * Opioid pain medications (slows motility) and antibiotics * Acute gastroenteritis

Answer 35

Pathogenic bacteria release a toxin called cytolethal distending toxin (CDT). A small portion of CDT resembles nerve cells in the small intestine called interstitial cells of Cahal (ICC). The ICC are responsible for the MMC - a peristaltic movement that sweeps bacteria into the colon. Through the autoimmune process of molecular mimicry, in response to CDT-B, the ICC can incur enough damage to negatively affect the MMC, resulting in SIBO.

Answer 36

SIBO can damage the villi of the small intestine, reducing enzymes like lactase (=lactose intolerance) and diamine oxidase (DAO) that are produced in these finger-like projections. DAO metabolises histamine in the GIT, therefore less DAO can result in reactions to high histamine foods (hives, migraines). *A client presenting with multiple intolerances, including to histamine, should be automatically screened for SIBO.*

Answer 37

Reduce food sources for the bacteria * Low FODMAP for up to 6 weeks * Specific Carbohydrate Diet (SCD) preferable to FODMAP if there is intestinal inflammation * May combine dietary models in severe cases.

Answer 38

Use 1-3 of the following anti-microbials in the initial phase of a SIBO plan. Use for 4-8 weeks: * Berberine – inhibits protein synthesis of bacteria, blocks TLR4 pathway * Oregano oil - affects bacterial cell membrane permeability * Allicin – for methane producing bacteria * Neem * Uva ursi and cinnamon

Answer 39

**Digestive support** * Digestive bitters (dandelion, rocket, watercress) * Betaine HCl, digestive enzymes, ACV **MMC support** * 12 hour overnight fast * Meal spacing (4 hours minimum), no snacks * Pro-kinetic agents before bed (ginger, artichoke) * Mindful eating, diaphragmatic breathing exercises

Answer 40

* Frequent UTIs * Fatigue * Digestive symptoms * Sugar cravings * Joint pain * Depression * Anxiety * Brain fog * Food sensitivities * Skin and nail fungal infections

Answer 41

* Candida is usually kept under control by native bacteria and the immune defences but **Disruption of the host bacterial environment** or immune dysfunction can allow **opportunistic** candida to proliferate (terrain theory). * C. albicans (produces many toxins and can suppress immune function) then penetrate epithelial cells and switch morphology from **commensal to pathogen.** * Infections are usually limited to the mouth or genitals and skin.

Answer 42

* Antibiotic use * Low immunity (↓ SIgA) * Chronic stress (↑ cortisol) * ↓ digestive secretions * High sugar intake * Dysbiosis * Impaired liver function * Exposure to toxins

Answer 43

* Stool test * Organic acids test (↑ arabinose) * Saliva test (candida antibodies) * Blood test (candida antigens)

Answer 44

Upon waking spit into a glass of water. Healthy saliva floats but if you see strings coming down or it sinks, you may have candida overgrowth.

Answer 45

Create an environment where candida cannot overgrow while optimising the body’s ability to heal naturally 1. Optimise elimination and detoxification 2. Adopt an anti-candida diet 3. Use natural antifungals and address biofilms 4. Address predisposing risk factors 5. Support the microbiome 6. Restore nutrient deficiencies

Answer 46

* Resolve any constipation * Stay hydrated * ↑ intake of soluble fibre and eat foods rich in mucilage * Flaxseeds, chia seeds, psyllium husk * If necessary, milk thistle to enhance liver function (protects against phase I metabolites - increases glutathione and SOD) * Consider a binding agent to mop up potential candida die off

Answer 47

* Lactoferrin * Lactoglobulin * Chlorella

Answer 48

* Eliminate refined sugars and minimise carbohydrates * Go gluten/dairy free * Eat lots of non starchy vegetables and low sugar fruit * Eliminate yeast or mould-containing foods (alcohol, cheese, dried fruit, vinegar, peanuts) * Opt for organic where possible * Reduce oxalates (impair enzymes which help the body to eliminate candida).

Answer 49

* Take 1 biofilm and 2 antifungal agents for 3 months * Start slow and build up to prevent die off symptoms

Answer 50

Berberine caprylic acid Pau d'Arco oregano thyme rosemary allicin

Answer 51

* Proteolytic enzymes * Serrapeptatse * Plant based * Allicin, curcumin, berberine

Answer 52

* stress * poor sleep * alcohol, sugar smoking * some medications

Answer 53

Crystalline calculi formed within the gallbladder from a build up of bile components.

Answer 54

- Gallstones form when bile becomes supersaturated with cholesterol, either because there is too much cholesterol or because there are not enough bile salts and phospholipids to keep it dissolved. - Biles stasis or delayed gallbladder emptying due to ↓ gallbladder motility

Answer 55

* T2D * OCP * HRT * Typical western diet * Sedentary * Obesity * High alcohol

Answer 56

* ↑fibre * ↓ refined sugar, trans fats, saturated fats and alcohol * Consume choleretic and cholagogue-rich foods and herbs to support bile flow * ACV * Bitter greens * Globe artichoke * Weight loss * ↑ PUFAs as found in oily fish * Peppermint (terpenes help to dissolve stones)

Answer 57

* Vitamin C (500-2000mg/day) * Lecithin (high phospholipid content; keeps cholesterol in solution) * Purified bile salts (ox bile)

Answer 58

1. Perform the liver flush for 10 days 2. On the evening of the 10th day, mix ½ pint of lemon juice with ½ pint olive oil. The cycloartenol content of olive oil is thought to aid bile flow. 3. Lying on your sofa on the right side, drink this mixture in small sips until it is finished 4. Prepare a castor oil pack and place over liver region 5. Go to bed with a hot pack over the castor oil pack 6. In the morning, sift your first bowel motion and look for stones **Do not perform with active cholecystitis** ## Footnote Liver Flush: Make a smoothie with the following ingredients, drinking it first thing every morning for 10 days (do not eat for two hours after drinking): - Juice of a whole lemon or lime - 1 garlic clove - 1⁄2 pint / 1⁄4 litre fresh pressed apple juice (or carrot, celery or beetroot juice) - Tbsp extra virgin cold pressed olive oil - Small piece of grated fresh ginger. - Optional: Pinch of cayenne powder.

Answer 59

Peptic ulcers = ulcers of the stomach (gastric) or duodenum characterised by a breakdown of the mucosal barrier and erosion of the regions wall by HCl.

Answer 60

- epigastric pain (may radiate to the back) - gnawing / pain between meals - nausea, vomiting - ↓ appetite - dyspepsia

Answer 61

- GIT bleed (persistent small loss of blood or large haemorrhage) - perforation (→ peritonitis). Seek urgent medical attention if: - sudden sharp worsening abdominal pain - haematemesis (vomiting blood) - melaena.

Answer 62

* **Stress** (sympathetic dominance) - can lead to vasoconstriction and inadequate blood supply which interferes with mucus production and reduces the secretion of protective prostaglandins. * **Low antioxidant status** and **low gastric output** - may predispose H. pylori colonisation. * **NSAID use** (↓ gastric prostaglandin synthesis, ↓ gastric mucosal blood flow and mucus production; interferes with the repair of superficial injury). * **Smoking, caffeine, alcohol** (damage the mucosa).

Answer 63

peptic ulceration chronic gastritis gastric cancer

Answer 64

Its corkscrew shape enables it to burrow through the protective mucus layer into the stomach lining, causing **inflammation**. H. pylori secretes cytotoxins and enzymes; e.g., protease, phospholipase and urease (releases ammonia) and **damages the mucosal barrier**. Numerous strains vary in their ability to trigger inflammation (virulence factors CagA and VacA carry greatest risk).

Answer 65

* **Avoid potential GI mucosal irritants**: alcohol, smoking, fizzy drinks, spicy foods, caffeine, NSAID use. * **Increase fibre** - especially for duodenal ulcers as fibre slows gastric emptying. * **Address stress**. Consider calming nervine teas (e.g., chamomile, passionflower). * **Support the mucosal / mucin barrier**: ‒ Demulcent herbal powder - slippery elm, marshmallow, liquorice. ‒ ↑ dietary polyphenols and seaweeds / algaes (fucoidan content). * **Raw cabbage juice** - a traditional remedy for healing stomach ulcers. Contains vitamin C and ‘substance U’ which stimulates mucin production (250 ml 4 x / day showed ulcers healed in 7‒10 days). * **Turmeric** - anti-inflammatory - ↓ inflammatory cytokines and pro-inflammatory PGs (600 mg 5 x / day showed ulcers healed after 12 weeks). * **Aloe vera juice** - 20–30 ml 3 x daily. Inhibits COX (antiinflammatory), speeds up wound healing (↑ collagen synthesis). * Identify and **address H. pylori**.

Answer 66

* **Saccharomyces boulardii** (↑ SIgA and mucosal barrier; inhibits colonisation and adhesion of H. pylori; inhibits IL‐8 and TNF‐α). * **Mastic gum** - dried sap from the mastic tree with ulcer-healing properties. It is anti-bacterial; thought to relate to its triterpenic acid content. 2 x 500 mg capsules before bed (30 days), then 1 x 500 mg capsule before bed (60 days). * **Liquorice** - contains flavonoids that inhibit H. pylori protein synthesis; it is anti-adhesive. * **Cinnamon** inhibits urease * **Berberine** containing herbs e.g., barberry bark * **Curcumin** from turmeric inhibit H. pylori growth * Also consider **probiotics** to outcompete H. Pylori.

Answer 67

**Gastro-oesophageal reflux disease** = the reflux of gastric juice (HCl, bile, pepsin) back into the oesophagus. Associated with transient lower oesophageal sphincter (LOS) relaxation episodes and a decreased lower oesophageal sphincter pressure. The most common symptom is heartburn (retrosternal pain). Often treated conventionally with chronic PPI use.

Answer 68

* ↑ intra-abdominal pressure: Obesity, pregnancy. * Hiatus hernia (stomach protrudes through the diaphragm into the thoracic cavity). * Eating large amounts of fatty foods (acid remains in stomach longer). * Smoking, alcohol, coffee; peppermint, tomatoes and chocolate relax the LOS. * Certain medications: Calcium channel blockers, nitrates, NSAIDs, diazepam. * Stress, anxiety and family history.

Answer 69

* Test for H.pylori. * Test for low stomach acid: ‒ Poor gastric digestion due to low HCl leads to fermentation of undigested food creating gas in the stomach and increasing pressure on the LOS. ‒ Correct low stomach acid using *digestive bitters, ACV, bitters, betaine HCl*. Consider *digestive enzymes*. * Avoid trigger foods / drinks and any foods associated with a food sensitivity or allergy, e.g., wheat. * A Mediterranean diet has been shown to be protective. * Use demulcent herbs to soothe and coat the oesophageal mucosa. *Slippery elm* (2–3 tsps. daily; mix into water (1 tsp:250 ml water). Can also use: *marshmallow root, liquorice, meadowsweet, prickly pear*.

Answer 70

* Slow down, chew thoroughly, eat mindfully, don’t overeat (or too late - within 3 hours of bed), do not drink with meals. * Avoid lying down post meals; when sleeping elevate the head of the bed (by up to 20 cm). * Address stress and anxiety. Lose weight if applicable. * Visceral manipulation of hiatus hernia. Also ↑ fibre to ↓ straining.

Answer 71

– Coeliac disease (auto-immune). – Wheat allergy (allergic). – Non-coeliac gluten sensitivity (innate immunity).

Answer 72

Gluten is the main structural protein complex of wheat, rye and barley that is difficult for humans to digest and can lead to many symptoms within, and outside, the GIT. The immune-trigger protein fractions of gluten include gliadins and glutenins.

Answer 73

An **IgE-mediated allergic response** that can develop within minutes to hours of exposure to wheat (digestion or inhalation). More common in children and many outgrow condition by aged 16. Symptoms include irritation or swelling of the mouth and throat, hives, itchy rash, nasal congestion, headache, nausea, vomiting, GORD, difficulty breathing, diarrhoea and anaphylaxis.

Answer 74

Coeliac disease (CD) = an autoimmune condition whereby the immune system can attack the mucosal lining of the small intestine in response to gluten, resulting in villous atrophy and malabsorption. Complications: Malabsorption (e.g., B12, B9, iron, calcium), osteoporosis, anaemia (iron / megaloblastic).

Answer 75

* abdominal pain * nausea * vomiting * diarrhoea * steatorrhoea * fatigue, anxiety * anaemia * weight loss * failure to thrive * osteoporosis * malnutrition * dermatitis herpetiformis * ataxia

Answer 76

* An inappropriate adaptive immune response to gluten-derived peptides (i.e., gliadin). * Gliadin is modified (cross-linked) by tissue transglutaminase (tTG) to allow gliadin to be presented to the immune system. * ‘Antigen presenting cells’ target gliadin and take up tTG-gliadin complexes producing autoantibodies and inflammation which damage the villi. * Gluten upregulates zonulin - a peptide known to reversibly regulate intestinal permeability by disassembling intercellular tight junctions.

Answer 77

* Blood test for: IgA anti-tissue transglutaminase (tTG) antibodies (first choice). IgA anti-endomysial antibodies (EMAs). * Blood or saliva test for human leukocyte antigen (HLA) gene: HLA-DQ2 or HLA-DQ8. * The gold standard for a CD diagnosis is a duodenal biopsy of the small intestine to detect villous atrophy. *All tests (except HLA) requires a gluten-containing diet for > 6 weeks*.

Answer 78

* Coeliacs must follow a completely gluten-free diet for life. * For optimum recovery, a gut-healing diet such as the specific carbohydrate diet (SCD) can also be used. * Address nutritional deficiencies. * Support the intestinal barrier (‘repair’).

Answer 79

Non-coeliac gluten sensitivity (NCGS) = the development of GI and extra-intestinal symptoms upon gluten ingestion in people not affected by coeliac disease or wheat allergy. *Intestinal:* Bloating Abdominal pain Diarrhoea Nausea GORD Constipation *Extra-intestinal:* Tiredness Headache Anxiety Brain fog Joint pain Depression

Answer 80

the role of innate immunity is suspected (i.e., ⍺-gliadin causing the release of zonulin from intestinal mucosa, inducing tight-junction disassembly and an increase in gut permeability).

Answer 81

Diagnosis is by way of exclusion, i.e., the resolution of symptoms when gluten is withdrawn and the relapse of symptoms with gluten exposure.

Answer 82

Bread Breadcrumbs Pasta Cereal Cake Biscuits Flour Sausages Soy sauce

Answer 83

An umbrella diagnosis used to classify an individual with a constellation of chronic symptoms. It is not a ‘disease’. It is the most common GI diagnosis globally — a prevalence of 11%.

Answer 84

Key symptoms: • Abdominal pain and cramping relieved by passing a stool. • Diarrhoea, constipation or mixed. • Bloating and flatulence. • Incomplete emptying of bowels.

Answer 85

IBS-C: Constipation IBS-D: Diarrhoea IBS-M: Mixed IBS-U: Unclassified

Answer 86

1)↑ dietary fibre and stay hydrated. 2) Magnesium (e.g., magnesium citrate — increase dosage from 250 mg gradually until tolerance). 3) Vitamin B5 and ginger (↑ peristalsis). 4) Psyllium husk or ground flaxseed (15‒30 g / day). 5-HTP (for some). 5) Natural laxatives e.g., prunes, figs. Pour prune juice over freshly ground flaxseeds (leave it in the fridge).

Answer 87

• ↑ soluble fibre to help bulk stool e.g. apple pectin. • Enteric-coated peppermint oil. • Digestive enzymes. • S. boulardii (↑ sIgA). • Electrolyte replacement, juices and broths to account for fluid / electrolyte losses. • Marshmallow root, slippery elm, meadowsweet (powder).

Answer 88

a group of autoimmune conditions of the colon and small intestine. Crohn’s disease (CD) and ulcerative colitis (UC) are the principal types of IBD.

Answer 89

Key symptoms (peaks 15‒35 years): – Abdominal pain and diarrhoea. – Urgency to pass stools. – Rectal bleeding (more so in UC). – Weight loss. – Fatigue (blood loss and malabsorption).

Answer 90

‒ colorectal cancer - osteoporosis - anaemia (e.g. iron, folate, B12).

Answer 91

Crohns: Any part of the GIT but mostly the terminal ileum UC: Colon and rectum

Answer 92

Crohns: skip lesions, all layers (transmural) UC: proximally continuous, mucosa only (‘ulcers’)

Answer 93

Crohns: crampy abdominal pain (right). Loose semi-solid stools UC: Abdominal pain (left side), bloody diarrhoea

Answer 94

Crohns: crampy abdominal pain (right). Loose semi-solid stools UC: Abdominal pain (left side), bloody diarrhoea

Answer 95

Crohns: Fistulas, abscess, obstruction, malabsorption - B12 deficiency. UC: Haemorrhage ➡️ anaemia

Answer 96

* IBD is characterised by the interaction between a genetically-susceptible individual and environmental factors, which have an impact on gut microbiota composition, triggering overly aggressive T-cell responses. * Genetics - there are at least 163 genes involved in IBD. Many are shared between UC and CD but some are unique to each. * Damage to the mucosal lining is very much associated with IBD.

Answer 97

* Very low / missing Akkermansia spp., ↑ R. gnavus and R. torques → *mucus degradation*. * *Raised gram-negative bacteria* (e.g., Fusobacterium nucleatum) create a high LPS load, which in itself ↑ immune response. * Bacteroides fragilis (enterotoxigenic) has also been associated as a trigger for IBD (its toxins destroy intestinal tight junctions). * A *lack of commensal bacteria* diversity (especially the SCFA- producers) - necessary in times of mucosal tissue repair. Lower numbers of F. prausnitzii, a bacterium that generates anti-inflammatory metabolic by-products, e.g., SCFAs incl. butyrate

Answer 98

Certain environmental factors alter mucosal barrier integrity, the immune response, or GI ecology: • Medication use: Antibiotics, NSAIDs, oral contraception. • Smoking (particularly CD). • Stress. • Infections (e.g., viral). • Poor diet (e.g., ↓ fibre = ↓ commensal substrates and ↓ SCFAs; ↓ omega-3’s, ↑ arachidonic acid, ↑ refined sugars). Also, food additives such as carrageenan.

Answer 99

* Remove inflammatory foods / beverages (e.g., dairy, gluten, refined sugars, coffee, alcohol, damaged oils). * Consider a low reactive dietary model such as SCD (especially for CD) or low FODMAP. * Include well-cooked foods (slow-cooked at a low temperature) as well as soups, stews and broths that are easy to digest and nourishing. * Consider an elimination diet to identify problematic foods. * Optimise omega-3 to 6 ratio (e.g., skinless oily fish) — can also be addressed via supplementation. * Fresh green juices (chlorophyll rich, anti-inflammatory).

Answer 100

* *Vitamin D* - stabilises tight junctions, regulates mucosal inflammation and supports commensal bacterial colonisation. Supports immune function (↓ inflammatory cytokines, e.g., TNF-α). * *Fish oils* (4.5 g / day) - DHA and EPA have profound anti- inflammatory effects, inhibiting NFκB, TNF-α and IL-6. * Supporting the mucosal / epithelial barrier: – Demulcent herbs (*marshmallow root, slippery elm*). – *Green tea* - catechins and epicatechins support the mucosal barrier; inhibits COX-1 and 5-LOX. – *Vitamin A, N-acetyl glucosamine, zinc carnosine, L-glutamine*

Answer 101

* *Ginger* (e.g., fresh or powdered in food; grated ginger steeped in hot water) - inhibits LOX, COX and TNF-α. * *Turmeric* (2 g+ daily) - inhibits COX-2 and NF-kB. * *Quercetin* - inhibits LOX and COX; down-regulates NF-κB. * *Aloe vera* - inhibits COX and supports wound healing. * *Bowellia serrata* (frankincense) - inhibits 5-LOX. * *Chamomile* (infusion 2 tsp. dried herb) - inhibits COX-2 and NF-Κb inhibition). * *Lion’s mane* mushroom - promotes regeneration of the intestinal mucosa; acts as a prebiotic; immune-modulating.

Answer 102

* *Probiotics* - species of Lactobacilii (E.g., L. acidophilus, L. casei) and Bifidobacteria have been shown to strengthen the epithelial barrier function and reduce inflammation. Advisable not to use in a flare. * *Prebiotics* (e.g., FOS, psyllium) - bacterial fermentation of prebiotics = SCFAs, e.g., butyrate. * Prioritise *nutrient deficiencies* in IBD: Vitamin *B12* (esp. in CD), *folate* (depleted by methotrexate), *iron* (bleeding), *zinc* (poor absorption and faecal loss), *calcium* (low absorption, vitamin D deficient), *potassium* (diarrhoea), *magnesium, vitamin A / D / E / K.*

5. GASTROINTESTINAL HEALTH Flashcards

This module covers: • Digestive insufficiencies. • The mucosal barrier. • Elimination diet. • The 5R protocol. • Dysbiosis. • Metabolic endotoxaemia. • GI disorders.