Digestion (week 4) Flashcards
functional categories and frameworks
cofactors (vitamins and minerals)
mucus membrane support
tissue repair
digestive stimulus
replacements
immune modulators
glandular extracts
adaptogens
Cofactors (vitamins and minerals)
Provide the micronutrients required for catabolic and anabolic chemical reactions
Supply the required nutrients for form and function, including the activation, regulation, and building blocks (substrates) needed for enzymes to work
EX: Zinc is the mineral cofactor for carbonic anhydrase, the enzyme responsible for synthesizing HCL
mucus membrane support
Soothe tissues and bolster the protective mucus coating of the upper GI tract and intestines
EX: Demulcents – licorice root, aloe vera, slippery elm, etc.
Often used to soothe and restore mucous membranes before other approaches like increasing acidity
tissue repair
Increase the supply of readily available and easily absorbed nutrients that speed the processes of cell renewal and tissue repair
EX: L-Glutamine promotes enterocyte proliferation, regulates tight junction proteins, lowers inflammation, and protects enterocytes against
cell death during high oxidative stress
digestive stimulants
Elicit the body’s own digestive secretions:
EX: Digestive bitters
-Stimulate the secretion of hydrochloric acid
-Gentian root
EX: Choleretics
-Stimulate the release of bile
-ACV, turmeric, dandelion root, and dietary choline or lecithin, etc.
replacements
Direct addition of digestive or hormonal compounds either synthetically produced, animal-based, or plant-based
Our goal is always to support the body’s innate ability to produce its own hormones, enzymes, digestive juices, etc (endogenous), however, there are times when supplying an outside source (exogenous) can help overcome long-term imbalances, allow the body to reset and regain its own function, or compensate for a permanent loss of function
EX: Betaine HCL, ox bile, digestive enzymes
immune modulators
Directly inhibit, stimulate, or modulate the production of transcription factors on immune-related genes (influence gene expression), immune signaling compounds, and function of immune cells
EX: Nettles, quercetin: mast cell stabilizers, reduce histamine release
EX: Colostrum: produced by mammals after birth, contains immune factors like antibodies, exerts immune effects in the GI tract
microbiome modulators
Directly alter microbial populations via inoculation, prebiotics, or antimicrobials
Probiotics – inoculation with living microbes
* EX: Saccharomyces boulardii reduces Clostridium difficile infection. When S. boulardii is given to antibiotic-exposed mice or patients with diarrhea, normal microbiota is re-established more rapidly
-Helps re-establish healthy symbiosis between multiple populations of beneficial microbes
-Oregano oil - broad-spectrum antimicrobial activity
Glandular extracts
Not just organs – includes endocrine glands
Oral consumption is theorized to be effective based on three main categories:
-hormonal, enzymatic, and nutritive
Remains controversial in terms of hormone content, digestion of bioactive components, safety (non-standardized), etc.
Backed by biological rationale as well as traditional, anecdotal, and clinical evidence
-EX: Adrenal – low adrenal output or recovery from stress
-EX: Pancreas – serves as a glandular (endocrine) as well as a replacement because it contains pancreatic enzymes (exocrine)
adaptogens
over 50 plants have been reported to fit the criteria of being adaptogenic in their action.
increase the body’s ability to cope with internal and external stresses
stimulating effects after both single-time use and prolonged use, leading to increased working capacity and mental performance under stressful and fatigue inducing conditions without increasing oxygen consumption
normalize the functions of the body irrespective of nature of stressors
no negative side effects
Ex: red ginseng normalizes stress hormone levels and has been shown to reduce visceral hypersensitivty of IBS
The 5 R’s in restoring gut health
remove, replace, reinoculate, repair, rebalance
Remove:
In this step, you are looking to remove stressors and irritants. This can include things like foods that directly burden the north-to-south process in some way, microbial infections or overgrowths, or foods that someone may be allergic or intolerant to. Medications may also serve as an irritant, but you want to avoid recommending someone discontinue a prescription medication without oversight by a prescribing physician. So, in this step, we may think about elimination trials or testing to help identify food hypersensitivities or intolerances, or we may consider microbiome modulators like antimicrobials and antifungals to help remove the obstacles to optimal function. It is important to know that this “removal” may be short-term. We don’t want to let our thinking get too boxed in to “remove, remove, remove.”
Replace:
In this step, we want to focus on replacing key nutrients that may be missing from the diet. So, incorporating a nutrient-dense, properly prepared, whole- food diet is at the heart of this step. Also, ensuring that there is enough stomach acid, digestive enzymes, and bile being produced and secreted to ensure digestion and absorption. Adding bitters, HCl, vinegar, digestive enzymes, or bile support can be incredibly helpful to get someone back on track.
Reinoculate:
Here, we are working to fortify and diversify the beneficial populations of the gut microbiota. This is where we would use probiotic-rich food and drinks like sauerkraut, kombucha, kefir, kimchi, miso, etc. In some cases, probiotic supplements will be helpful. Additionally, ensure that the diet is rich in
enough prebiotic fiber and starches to serve as food for healthy bacteria to flourish. Foods rich in prebiotics include garlic, asparagus, onions, leafy greens, whole grains (quinoa, oats), apples, flaxseed, lentils, and jicama - if tolerated.
Repair:
Once we have removed obstacles, replaced nutrients or digestive aids, and started working on balancing the microbiome, it is time to work on repairing the integrity of intestinal walls. This involves adding essential key nutrients for tissue
repair like l-glutamine, gelatinous broths and/or collagen peptides, zinc, and vitamins A/C/D/E, etc.
Rebalance:
In this last step, I like to think about addressing the many lifestyle factors that also play a role in optimal health. This means encouraging a client to
realize the value of good hydration, stress management, daily movement, recreation
and creative self-expression, social connection, and of course, good quality sleeping- all of which will allow the nutritional work you are doing to be effective.
phytonutrients
phytochemicals
bioactive compounds found in plant foods - associated with many health benefits
~10,000 types
some top subtypes relevant to digestion: carotenoids, chlorophylls, curcumoids, organosulfur compounds, terpenes, and polyphenols
Carotenoids
re, orange, and yellow pigments
beta-carotene, lycopene, lutein, and zeaxanthin
potent antioxidants
beta-carotene can reduce LPS-induced intestinal inflammation and increase the expression of tight junction proteins (barrier function)
chlorophylls
green pigments needed for photosynthesis in plants
potent antioxidants
detoxification of heavy metals, environmental pollutants, and aflotoxin
anti-inflammatory properties and promote the healing of wounds and support tissue regeneration
act as internal deodorant
curcuminoids
includes curcumin
possess antioxxidant, anti-inflammatory, and potentially anticancer properties
reduced relapse rates and symptoms in patients with IBD (crohns disease and ulcerative colitis)
organosulfur compounds
sulfur containing phytonutrients in alliums (garlic, onion, shallot) and cruciferous vegetables (broccoli, cauliflower brussel sprouts)
include allicin and sulforaphane
antioxidant, anti inflammatory, and potential anti cancer effects
can be clinically useful in SIBO and have roles in detoxification and immune regulation
terpenes
large component of the essential oils
include limonene, linalool, and menthol
aroma and flavor
antioxidant, anti-inflammatory, and antimicrobial properties
EX: oregano’s antimicrobial properties from terpenes carvacrol and thymol
polyphenols
possess strong antioxidant and anti-inflammatory properties
exert beneficial effects on the intestinal microbiota
over 8,000 known types of polyphenols widely distributed in foods
ex: flavonoid (many subtypes including anothocyanins in berries and catechins in tea and cocoa beans)
ex: flavonols (quercetin)
polyphenols
secondary metabolites:
-not directly involved in the growth, development, or reproduction of the plant
-response to environmental stress
-protective properties conferred to humans when consumed
-can be toxic if consumed in excess
metabolism of polyphenols:
-microbes in the gut break down complex polyphenols into smaller metabolites that can be utilized by the body
-microbial metabolites contribute to the overall health benefits associated with polyphenols
polyphenols impact on digestive tract
Prebiotic:
-act as a food source for beneficial bacteria such as Bifidobacteria and Lactobacilli
Microbial diversity:
-associated with increased microbial diversity
-ex: polyphenols in cranberry, grape, pomegranate, and EGCG from green tea boost levels of Akkermansia muciniphila which helps to promote mucosal integrity and mitigate diabetes and obesity
intestinal barrier function:
-individuals who consumed a polyphenol rich diet exhibited reduced levels of zonulin (a marker of intestinal permeability), higher levels of short chain fatty acids such as butyrate, and reduced levels of pathogenic microbes
antimicrobial effects:
-inhibit the growth of harmful bacteria or pathogens
Herbs & Spices
used across time and cultures to promote healthy digestion
herbs: the leaves of a plant (fresh or dried)
spices: roots, stems, flowers, seeds, and berries
aid in the breakdown and absorption of nutrients
provide comfort and relief to digestive system
Herbs & spices
turmeric:
-reduces bloating, prevents ulcers, gastric infections
-reduces relapse/severity of IBS and IBD
-rich in curcumin
-increases microbial diversity in the gut
-fatty acids and black pepper increase absorption
cinnamon:
-increases appetite, eases gas, burping, bloating in IBD
-reduces H. pylori
-rich in antioxidants and polyphenols
-plays a role in blood glucose regulation
ginger:
-eases indigestion, reduce nausea
-naturally increases digestive juices
-increase peristalsis
-anti-microbial and anti-inflammatory
Cardamom:
-healing stomach ulcers
-reducing inflammation
peppermint:
-eases stomach discomfort and reflux
-can cause transient (temporary) relaxation of LES
slippery elm:
-prebiotic
-positively influences gut microbiota
-treats heartburn/relux
-increases mucous production and supports gut lining
Fennel:
-relieves bloating and gas
-increases appetite
caraway:
-eases stomach cramping and nausea
-dissipates gas
garlic:
-anti-microbial properties
-contains inulin, a powerful prebiotic
oregano:
-anti-microbial
-can be used to treat dysbiotic condition in the gut
helping clients incorporate herbs & spices
help clients get more familiar + better access
asking clients what they have, what are they open to trying?
buying in bulk
potted/planted herbs
new recipes for clients: curries, roasting blends, perstos, gremolata, chimichurri
probiotic rich foods
beneficial microbes
aids in digestion
nutrient breakdown and liberation
nutrient conversion
“fermentation is a health regimen, a gourmet art, a multicultural adventure, a form of activism, and a spiritual path, all rolled into one” -sandor katz
Fermentation types
differ based on types of organisms, substrates, and environments
Lacto-fermentation:
-more lactic acid producing bacteria
-requires low oxygen environment (anaerobic)
Ex: kimchi, sauerkraut, kvass
SCOBY: symbiotic colony of bacteria nad yeast
-more acetic acid producing yeast and bacteria
-form a cellulose-based biofilm
Ex: apple cider vinegar, kombucha
Kefir “grains”
-both lactic and acetic acid producing bacteria and yeast
-protein matrix called kefiran
Ex: dairy kefir, water kefir grains
Mycelium: mold and fungi
-Ex: tempeh, miso (koji)
Wild vs Cultured Ferments
Microorganisms:
-Wild = naturally occurring microorganisms present in the environment
Ex: lactobacillus bacteria on cabbage + salt and water
-Cultured = direct inoculation with specific strains of microbes
Ex: yogurt with starter culture
Control:
-Wild = less predictable and less control; flavor, aroma, and quality vary from batch to batch
-Cultured = more control, consistent results
Time and Speed:
-Wild = slower fermentation process
-Cultured = accelerate the fermentation process
Purchasing Fermented Foods
not all fermented foods are created equal
read ingredient labels:
-look for probiotics low in added sugar/flavorings
-organic, grass fed when possible
-DIY
Raw/Living vs Pasteurized
-look in refrigerated section of store
-metabiotics - still carry some benefits after fermentations have been cooked/killed
Categories of Prebiotics: Fructans
Fructans: includes inulin and fructooligosaccharides (FOS)
-Inulin:
-soluble fiber
-found in chicory root, jerusalem artichokes, onions, garlic, leeks
Criteria for Prebiotics
- resistant to gastric acidity and hydrolysis by mammalian enzymes and GI absorption
- Can be fermented by intestinal microflora
- selectively stimulates the growth and.or activity of intestinal bacteria associated with the health and wellbeing of the host
selective =
Categories of Prebiotics: Froctooligosaccharides (FOS)
-Froctooligosaccharides (FOS):
-a group of prebiotics composed of short chains of fructose
-bananas, onions, garlic, asparagus, wheat
Categories of Prebiotics: Galactooligosaccharides (GOD)
Galactooligosaccharides (GOD):
-made up of short chains of galactose
-legumes (beans, lentils), human breast milk, some dairy products
-commonly used as prebiotic in infant formulas
Categories of Prebiotics: Pectin
pectin, or pectic oligosaccharides (POS).
Pectins are soluble fibers found in fruits, particulary the skins of apples and citrus fruits.
it can act as a prebiotic by promoting the growth of beneficial gut bacteria
Categories of Prebiotics: starch or glucose derived oligosaccharides
starch or glucose derived oligosaccharides: resistant starch is a type of starch that resists digestion in the small intestine and reaches the large intestine intact, where it can serve as a prebiotic
it is found in foods like unripe bananas, cooked and cooled potatoes, legumes, whole grains
they are particularly good at increasing levels of bifidobacteria and SCFA in the colon
Categories of prebiotics: beta-glucan
Beta-glucan: a type of soluble fiber primarily found in oats and barley
it has prebiotic properties and can stimulate the growth of beneficial bacteria in the gut
Prebiotic-rich diet
polyphenols (lots of colors, tea, etc). jicama, jerusalem artichokes, onions, garlic, leeks, bananas, asparagus, legumes and pulses, whole grains, apples, pears, berries, citrus (rind), unripe bananas/plantain, cooked and cooled potatoes, cactus (nopales), chicory root products
Excess may cause issues for some IBS, SIBO
low-FODMAP diets
fermentable oligosaccharides, disaccharides, monosaccharides, and polyols
in context of healthy system = beneficial to gut health
in context of dysbiosis or digestive disorder = can feed pathogenic/opportunistic overgrowth and exacerbate symptoms
low FODMAP diets often used to reduce symptoms in =IBS or SIBO
helpful in reducing symptoms of gas, bloating, abdominal pain, diarrhea, and constipation
long term use can reduce diversity and the amount of beneficial bacteria in the alrge intestine
ideally used as short term approach to symptom management only
low-FODMAP diets
Three phases
Elimination phase:
-all high FODMAP foods are restricted from the diet for a period of 2-6 weeks
Reintroduction Phase:
-individual FODMAP groups are systematically reintroduced
-tracking specific triggers of symptoms
-goal: identify personal tolerance to different types and amounts of FODMAPs (vs blanket elimination)
Personalization phase:
-diet is tailored to each individuals specific tolerances and preferences
food first approaches to support digestion
previously:
-phytonutrients & polyphenols
-herbs & spices
-probiotic rich foods
-prebiotic rich foods
this video:
-mushrooms
-leafy greens
-broths/peptides
-healthy fats
-vinegars and citrus
-water
Mushrooms
consumed as food and medicines throughout human history
nutrient dense: B vitamins, vitamin D, calcium, magnesium, zinc, iron, selenium, potassium, manganese, copper, phosphorous
rich in phenolic compounds: anti inflammatory, antioxidant, anti cancer properties
fiber content boosts gut health
mushrooms: 3 kinds of fiber
Chitin, Chitosan, Beta glucans
support growth of beneficial gut bacteria strains (bifidobacterium, lactobacillus, akkermansia, bacteroides)
reduce inflammatory microbes like H. pylori and c. Difficile
reduces firmucites to bacteroides ratio
supports integrity of gut barrier
increase SCFA byproducts butyrate and propionate
support integrity of gut-barrier
mushroom types
white button
cremini
portabella
shiitake
oyster
morels
porcini
chantrelle
reishi
lions mane
turkey tail
chaga
leafy greens
bitter greens stimulate the release of salivary amylase, stomach acid, bile, digestive enzymes
high in folate
folate:
-required for cell growth and repair
-folate deficiency can manifest as GI issues
-folate deficiency recognized as risk factor for inflammatory GI conditions
insoluble cellulose fiber in cell walls
sulfoquinovose: unique carbohydrate in greens acts as a prebiotic
rich in other beneficial micronutrients like potassium and phytonutrients like chlorphyll
high in oxalic acid content
-may be more of a concern for those with kidney disorders and possibly thyroid conditions
-reduced by stemming/boiling
how do you incorporate
kale
spinach
collard greens
beet greens
dandelion greens
artichoke leaf
cabbage
watercress
arugula
mustard greens
broccoli
broccoli sprouts
brussels sprouts
bok choy
romaine
cooked leafy greens are easier to digest than raw forms
bone broth
found in traditional diets worldwide
liberates nutrients that are otherwise difficult to access
great use of kitchen scraps
contains vitamins and some minerals - increased with vegetables and sea vegetables
glucosamine and chondroitin - joint health
proteins and amino acids
Collagen, Gelatin, and Collagen Peptides
Collagen protein:
-the most abundant form of protein in the human body
-found in connective tissues, bones, tendons, ligaments, and skin of animals
-many subtypes
-provide structure to skins, organs, joints, bones, and help regulate cell proliferation, migration, and differentiation
Gelatin:
-produced by cooking collagen-rich animal tissues in water
-gelatin rich broth turns to jelly when it is cooled
Collagen peptides:
-hydrolyzed collagen or collagen hydrolysate
-created with the addition of enzymatic aid
-smaller peptides/lower molecular weight compared to gelatin
-more soluble, can be mixed into cool liquids
offer similar health benefits due to their high content of amino acids, such as glycine, proline, and hydroxyproline
-powders can also be great additions to soups, hot teas
-all dietary protein is important for structure and function of digestive tract
Healthy fats: omega 3’s
promote levels of bifidobacterium, akkermansia, and lactobacillus
suppress e.coli and LPS
increase SCFA production
maintain integrity of gut lining
salmon, mackerel, herring, sardines, walnuts, flax, chia
healthy fats: extra virgin olive oil
increases bacterial diversity
-bifidobacterium, lactobacillus, bacteroides
reduces levels of opportunistic pathogens
boosts production of SCFAs
-reduces inflammation and improves gut barrier function
higher polyphenol content linked to many of the benefits
healthy fats: grass fed dairy fat
contains butyric acid (form of SCFA butyrate)
-feeds the cells of the colon
-butyrate alleviates some symptoms of IBD
conjugated linoleic acid
-anti-inflammatory
ghee: removes dairy solids (proteins and sugars) and reduces intolerances
vinegar and citrus
vinegar:
-fermentation of a liquid containing alcohol into acetic acid
-contains trace vitamins, mineral, amino acids, and polyphenolic compounds
-acetic acid: increase stomach acid production and help lower pH of the stomach, indirectly increase bile excretion
caution with acids:
-may exacerbate ulcers or inflamed mucus membranes (focus on soothing inflammation first)
-risk for tooth enamel erosion
-quick mouth wash, dilution, straws, or using dehydrated vinegar in capsules
lemon:
-similar pH and nutritional benefits, aids in liver detoxification
-maybe more tolerated than vinegar due to taste, sensitivity to base fruits, vinegar has higher histamine levels, or yeast sensitivity
water
hydration is essential for digestion
dehydration contributes to ulcers, reflux, constipation, bloating, nausea, bad breath, reduced saliva
water is best sipped throughout the day
be mindful not to dilute stomach acid during meals, or 30 minutes before or after
supplements for digestion: upper GI
Upper GI: soothing + tissue repair in stomach mucosal membrane
vitamin U
-s-methylmethionine (SMM), high in cabbage
-helps speed the healing of stomach ulcers
vitamin A
-anti-oxidant and help with cell regeneration
Gamma Oryzanol
-lipid extract from rice bran
-reduce symptoms of stomach pain and inflammation
Zinc Carnosine
-acts as an antioxidant in the digestive tissues
-speed the healing of peptic ulcers
Mucogenic herbs: contributes to protective membrane
-aloe vera, okra, marshmallow root, asian plantain, slippery elm bark
-licorice root- reduce inflammation and increase protective mucous in the upper GI
-lozenge and tea forms make contact with the esophagus
-DGL or deglycyrrhizinated licorice to avoid adverse reactions (blood pressure)
Melatonin
-anti inflammatory, supports LES, can help reduce the occurrence of acid reflux and GERD
L Glutamine:
(see small intestine)
supplements for digestion: upper GI
upper GI - stimulants for gastric secretions
Bitters:
-stoke the fire of digestion
-tinctures, teas, or raw herbs
-contact with taste buds to maximize effects
Ex: gentian root, bitter melon, artichoke leaf, burdock root, dandelion, cinnamon
Zinc:
-mineral cofactor for carbonic anhydrase enzymes which are needed for stomach acid production
supplements for digestion: upper GI
Upper GI - acid replacements
dehydrated vinegar:
-can be found in capsules for supplementation
-minimized acid contact with mouth/esophagus
hydrochloric acid:
-made by parietal cells of stomach, available in supplment form
-often found paired with pepsin, a protein digesting enzyme
-powerful digestive aid and north to south trigger
-requires practitioner and client education for safety
Supplements: Liver & Gallbladder
Liver / Gallbladder: bile production / gallbladder health
aforementioned northern digestive stimulants
Bitters:
-bile production and release
Vitamin C (ascorbic acid):
-enzyme cofactor required to turn cholesterol into conjugated bile acids
-can reduce total serum cholesterol and triglycerides
-improves bile consistency and reduce symptoms in patients with gallbladder stones
Taurine:
-incorporated into bile salt, increases the emulsifying quality of the bile
-increases fecal bile salts
-improves serum lipid markers
Pancrelipase (porcine)
-lipase enzymes aid with emulsification and digestion
Beets:
-contains betaine
-helps with bile viscosity and acts as a methyl donor in the phase 2 detoxification
Phosphatidylcholine
-solubilizes cholesterol in bile
-help maintain proper bile viscosity and flow
Supplements: Liver & Gallbladder
Liver & gallbladder - bile replacement
Ox bile:
-sourced from cattle
-bile salts act as an enzyme aid and a fat emulsifier to aid in the absorption of dietary fats and fat-soluble nutrients, help manage cholesterol homeostasis, and suppress the overgrowth of bacteria in the small intestines
long term gallbladder issues and poor bile output, or who no longer have a gallbladder
used with higher fat meals
Supplements: Pancreas
Pancreas - enzyme replacements
animal sourced:
-known as pancrelipase or pancreatin
-glandular extracts of amylase, lipase, and protease (majority proteases)
Plant sourced:
-Ex: bromelain (pineapple) and papain (papaya)
Microbe sourced:
-can provide a broader spectrum of digestive activity (protein, carbohydrates, fats, fibers)
Enzyme adaptation:
-the concern that external enzyme supplementation may downregulate endogenous production
-not much evidence for concern with moderate doses and periodic use
Supplements: small intesine
Small intestine: soothing + tissue repair in small intestine mucosal membrane
all of the aforementioned supports
similar nutrients to those that we mentioned for supporting mucosal membranes of the upper GI (s-methylmethionine, vitamin A, gamma oryzanol, zinc, mucogenic herbs)
L-glutamine:
-amino acid
-reduces intestinal permeability
-speed up healing of peptic ulcers
-normalizes the immune response and reduces inflammation
-plays an important role in maintaining healthy gut microbiota diversity
-improves gut barrier integrity by increasing. mucus production in the GI tract
-available in capsules or powder form
hydrolyzed collagen
Supplements: intestines
intestine - immune factors
Colostrum:
-first milk after giving birth, rich in immune factors
-dehydrate powder from goat or cows milk
-protects against pathogenic infections and reduces leaky gut
Quercetin:
-reduces the release of histamine = lowers inflammation and tissue permeability in the gut
Zinc and vitamin A:
-speed tissue repair
-support healthy levels of secretory IgA (peyer’s patches) and T-regulatory cells:
-sIgA deficiency s linked to allergic disorders, food intolerances, and susceptibility to dysbiosis and infection
-deficiency in zinc and vitamin A linked to sIgA deficiency
-vitmain A helps balance between Treg (pro-tolerance) and Th17 (pro-inflammation, tissue destruction)
Supplements: large intestine
large intestine - prebiotics
all of the afore mentioned supports
found in probiotic formulas - extend the life of the probiotics
synbiotics = formulas with pre + probiotics
availability in food reduces need for supplemental
may benefit those with severe GI issues who cant tolerate prebiotic foods
Ex: acacia fiber, 100% soluble fiber
may exacerbate some forms of dybiosis (SIBO)
start slow and gradually increase as tolerated
supplements: large intestine
large intestine: probiotics
food sources first
probiotic supplement allows for a more controlled, targeted approach
many forms, strengths, single strains of bacteria vs multiple strains
how to select the best probiotic?
-research by condition
-humans evolved to have thousands of different strains living in the intestines
see reference materials for guide to researching and evaluating the evidence for the use of different strains with different conditions
supplements: large intestine
large intestine - microbiome modulators/antimicrobials
caution: risk for damaging beneficial populations with long term/excessive use
-start low, slow, cycle on and off
-concurrent use with probiotics taken during same period, different types of day
Monolaurin:
-derivative of coconut oil with strong anti-fungal activity
-disrupts biofilms and can increase efficacy of other antimicrobial supplements
Berberine:
-plan alkaloid with strong, broad spectrum antimicrobial activity
-lowers glucose, effective in non-alcoholic fatty liver disease due to impacts on microbiome
Oregano:
-antioxidant, broad spectrum antimicrobial
supplementsL large intestine
large intestine - colonocyte energy and colonic transit
all of the aforementioned supports. first, consider any supportive nutrients that worked well for upper GI and/or liver/gallbladder and pancreas
short chain fatty acids
-nutyric-cal-mag
magnesium:
-relaxes muscle fibers and hydrates stool
-magnesium citrate most commonly used for constipation
water: hydrates stool
thyroid: full panel recommended for clients with constipation
Types of Food Reactions
Immunologic:
IgE allergies
Ex: Peanut allergy
rapid onset, allergic type symptoms
Non-IgE hypersensitivities (IgG, IgA related)
Ex: non-celiac gluten hypersensitivity
slow onset, systemic and digestive symptoms
Non-Immunologic:
Functional intolerance (digestive)
Ex: lactose intolerance
primarily digestive symptoms
Elimination Trials
an eating strategy that omits certain foods or food groups that are believed to be the potential cause of an adverse food reaction or other symptoms
“trial” vs “diet” connotates temporary eating pattern designed to provide actionable information
goal is to link reactions or symptoms with thw foods consumed
two main phases:
-elimination
-reintroduction
Elimination Phase
the more reactive foods removed in one trial, the more likely to clear results
strict elimination for a minimum of 4-6 weeks to get baseline
large elimination can be stressful, minimize eliminations with:
-pregnant and lactating people
-children
-high stress circumstances
-active or a history of eating disorders
educate clients on food labels / hidden sources
common reactive foods: gluten, dairy, eggs, soy, peanuts, shellfish, tree nuts, corn, and nightshades
Reintroduction phase
prepare your client for reintroduction ahead of time:
-written plan for reintroduction
-food journal to record the process
reintroduce over 3 days before moving to next food
Be specific! Example:
-use foods in their pure form (corn vs cornbread)
-low lactose dairy vs higher. is it lactose sugar or dairy proteins?
-milk and cheese separately
-egg whites vs yolks
-chicken vs duck eggs
efficacy of elimination trials
some non-IgE reactions can normalize after 6 months to 2 years of elimination, but some may remain active longer
true allergies and autoimmune triggers (gluten in celiac) should not be reintroduced
evidence supporting elimination trials for many conditions including IBS, eosonophilic esophagitis, ADHD, skin conditions, arthritis, migraines, and more
Free. Accessible
within scope of nutritional therapy practitioners
gluten free diets
celiac disease - a gluten free diet is necessary
non-celiac: gluten containing foods can be a trigger
-FODMAP content
-sensitivity to prolamins in cereal grains
-metabolic concerns with the high starch content of grains
-complex immune interactions
-presence of glysophate in wheat
-increases zonulin levels and intestinal permeability in the gut
-autoimmune thyroiditis
however, going gluten free needs not be a blanket recommendation for the general population. many people can tolerate it
dairy free diets
two things to distinguish:
1) lactose intolerance: inability to digest the sugar (lactose)
2) immunological response to dairy proteins
Lactose intolerance (functional intolerance):
-lactase enzyme deficiency in the small intestine
-primary: no other GI issues
-secondary: consequences of other gastrointestinal conditions.
-low lactose dairy may be tolerated, and supplementation with exogenous lactose enzymes can reduce symptoms
Dairy allergy or hypersensitivity (immunological reaction):
-adaptive cells of the immune system reacts to proteins in milk
-A2 certified cows produce different casein protein
-goats milk products
Low Lectin / low oxalate diets
referred to as “anti-nutrients”
lectins: proteins that bind to carbohydrates, found in all plant foods
agglutination: clumping effect, immune stimulant
can be largely inactivated by cooking and enzymes
Concerns:
-bind to intestinal cells, trigger inflammations
-impact intestinal permeability and tight junctions
interference with absorption of key minerals (calcium, iron, zinc, phosphorous) is more relevant in super high lectin/low micronutrient diets
lectin-containing foods also contain health promotion nutrients like prebiotic fibers and polyphenols
Low Lectin / low oxalate diets
oxalates:
-similar concerns as with lectins
-can increase risk for kidney stones
-some high oxalate foods are also power anti-inflammatories
proper food preparation can reduce content:
-soaking, sprouting, fermenting, boiling, steaming
bio-individuality
low histamine diet
we need histamine for many functions
~1% of the population experiences histamine intolerance
inability to properly break down histamine
histamine comes through three main pathways:
-mast cell activation: immune cells that release histamine when activated
-bacterial metabolism: byproduct from histidine (amino acid) consumption. Ex: enterobacter, citrobacter, morganella
-dietary intake: aged cheeses, fermented foods, cured meats
histamine metabolism
diamine oxidase (DAO): enzyme that degrades histamine
low histamine diet: avoids histamine containing foods, foods that trigger the release of histamine in the body, and foods that block DOA activity:
-alcohol, fermented foods & drinks, avocados, eggplant, spinach, some fish & shellfish, aged cheese, cured or processed meats, bananas, tomatoes, beans, papaya, chocolate, citrus, nuts, vinegar, and food dyes
-black and green tea may also block DAO production
food freshness: histamine may be reduced
DAO supplements are available
mast cell stabilizers
refer for testing with primary care provider
popular therapeutic diets
bio-individuality: there is no one-size-fits-all diet
adaptability and resilience:
-our goal is to reduce fear of food, and increase dietary diversity and resilience
-components that may potentially have a downside exist in every food - we evolved to adapt/hormetic stressors
Disordered eating:
-any type of elimination does carry some risk for triggering restrictive forms of disordered eating
-food restriction is not the only way to better health
nutrient diversity:
-diets that eliminate large food groups can be high in certain nutrients and low in others
Evidence changes:
-research is never done
-stay flexible and open-minded
lifestyle support strategies
relate back to supporting the parasympathetic state
mindful eating:
-slow down and sit down
-attend to tastes and textures
-turn off distractions and devices
chew properly
-mastication
-signals lower organs to prepare for digestion
manage stress
-stress associated with numerous GI conditions
-stress takes resources away from digestion
-help clients find practices that work best for them
move your body
-improved gut transit time, reduced constipation, improves postprandial glucose
-lowers inflammatory compounds, normalizing stress response, improving circulation
-simple/gentle movement can work
remove unsupportive habits
smoking:
-associated with reflux, ulcers, GI cancer, ulcerative colitis
-disrupts microbiome
alcohol:
-increases acid production
-GI inflammation
-disrupts the microbiome
late night snacking
-associated with reflux
-interrupts fasting time needed for GI rest and renewal
-interruption of MMC
Vagal Nerve Stimulation
improves gastric motility, reduces symptoms of IBS, normalizes stress response
-diaphragmatic breathing
-laughing and socialization
-gargling, singing, humming
-manual therapy: massage, acupuncture, acupressure
-cold water exposure
-meditation
build a referral network to serve your clients best
Providing recommendation guidelines
comprehensive guidelines = educate your client on not just what, but also how and why
what potential reaction can you prepare a client for?
course of action if they do have adverse reactions:
-temporarily stop the intervention to see if the symptoms resolve
-lower the dose/frequency
what concern/sign/symptoms were highly related to the recommendation and how could the supplement affect their physiology?
if recommending more than one, do they start all at once? which one to start first and when to add the next?
general + tailored guidelines
example of general supplement guidelines:
-put a few days of space between dietary changes and supplement changes
-begin only 1 supplement at a time
-work up to full amount, increasing by 1 every 1-3 days
-if at any point prior to the full amount you feel you’ve reached your ideal dose or experience a reaction, stop increasing and let me know
additional guidelines per supplement
increase guidelines for increased risk for irritation or adverse reaction
Herxheimer reaction & first pass metabolism
Herxheimer reaction:
-rapid die off of certain microbes
-drastic reduction in carbohydrates, increase antimicrobials, or beginning probiotics
-aggressive eradication protocols should be done with trained practitioners
First-pass metabolism
-a large portion of the nutrient rich blood coming from the intestinal venous system goes to liver first
-allows the liver the chance to filter and process whatever is coming in
-liver will feel the effects
Prioritization
complex client = more important to come back to the foundations
attend to the “low hanging fruit” or shiny new objects first
greatest benefits for the least effort, cost, and risk:
-what would have the greatest potential to benefit more than one foundation or sign/symptom at the same time?
-is there one recommendation that could potentially reduce more than one symptom?
-when considering supplements, which ones could easily be attained with therapeutic foods rather than a supplement?
-is there a more affordable approach to try first?
-are we following our north to south cascade?
stay flexible
the path to health is not a straight line but Is instead more of a dance
respect for bio-individuality
err toward caution, rather than advocate for someone to push through the symptoms
two people with same issues may do best with different approaches
Case study: susan
primary concerns listed:
-weight loss
-lack of focus, motivation, fatigue
-feels her depression has increased
-irritable before meals, and sleepy after meals
-upper GI symptoms: periodic heartburn, bloating, and a feeling of excessive fullness after meals
-chronic constipation
-craves sweets, but feels worse after eating
-recurrent yeast infections
-stress level is 7-8
-diet consists of a lot of grab and go snack foods high in carbohydrates, pastas, deli sandwiches, and some salads with limited protein and fat
where do we start?
symptoms may indicate low signaling and HCL production in the upper GI tract, overgrowth of yeast, slow motility - where to start?
-not just what, but how is she eating? parasympathetic tone
-factors that impair HCL production or LES function
-culinary ways to support acid production (apple cider vinegar, sour and bitter foods)
-move toward more nutrient dense, properly prepared, whole food diet
-reduce refined carbs and incorporate lacto-fermented veggies
-focus on simple & easy options
-compromise on homemade vs store bought with staples like broths and ferments
Next month:
-symptoms generally improved, but some shifted
-eating more fats in place of carbohydrate = developed more lower intestinal symptoms
-discover history of gallbladder removal:
-reassess macronutrient balance
/add liver and bile support-consider ox bile with higher fat meals
/review dietary fat quality
/which types of fats are most/least upsetting
/which fats might be most beneficial for susan in particular?
ex: coconut oil can provide energy but also have an anti-fungal effect
Another month later:
-continued improvement
-slight increase in sweets = candida symptoms
-60 day low carbohydrate + boost antifungals
/eliminate all grains and sweeteners
/moderately limit sweet fruits and starchy veggies
/incorporate culinary anti-fungal herbs and spices
/add monolaurin-based supplement
/add broad spectrum probiotic
supportive approaches
build on small cumulative steps
relies on assessing progress, and pivoting as needed
aligns with our N>S process
supports multiple parts of the digestive process
conservative use of supplements, emphasizes food first approach
supports more than one foundation
lowers symptoms burden
does not take place of appropriate medical care as needed
