Gastrointestinal Health Flashcards
3 e.g.s of herbs regarded as mucosal support for peptic ulceration
Marshmallow
Slippery elm
Liquorice
Herbal choleretics and cholagogues should be taken within how many minutes of starting a meal?
30 minutes
Symptoms associated with Ulcerative colitis
Left side abdominal pain and bloody diarrhoea
What does protein putrefaction create and what disease are these implicated in?
Polyamines
Colorectal cancer
What is the role of secretory IgA
An immunoglobulin that protects the intestinal epithelium from toxins and pathogenic microbes through a process called ‘immune exclusion’?
80% of gallstones contain what?
Cholesterol
What marker would you be looking for on a stool test to indicate intestinal tight junction permeability?
Zonulin
E.g. of a nutrient or herb that contains Helicobacter Pylori-inhibiting flavonoids
Liquorice
You suspect your client Petra has Candida. Give 3 possible reliable methods of testing for the presence of Candida?
Saliva test
Organic acids test
Stool test
The 5R program - what are the 5 steps?
Remove, replace, reinoculate, repair, rebalance
- Medical term for low stomach acid
- What constitutes a low stomach acid pH?
- Hypochlorhydria
- fasting gastic pH above 3
1.5-3.0 is normal
5 signs/symptoms of hypochlorhydria
- Gas and bloating less than 30 minutes after eating
- heartburn
- sensation of fullness after eating
- Foul-smelling stools
- Nausea after taking supplements
- Food allergies
What nutrient deficiencies can happy due to hypochlorhydria?
Iron
Zinc
Folate
B12
Due to malabsorption
3 complications of hypochlorhydria
- Reduced mineral absorption
- Protein putrification (can lead to inclrease polyamines with cancer risk)
- Higher pH means reduced protection from bacterial infection (H.pylori / SIBO)
- Poor pancreatic juice and bile flow (due to lack of acidic chyme)
5 natural approaches to hyprochlorhydria
- chew thoroughly
- dont drink with meals
- Apple cider vinegar 1-2 tsp diluted in a little water before meals
- Bitter foods
- Supplement with Betaine HCL
What are the basic protocol steps for supplementing with betaine HCL for a client with Hprochlorhydria?
- take 1 capsule (350-750mg) with a protein-containing meal
- If no sensation of burning, increase dose by 1 capsule every 2 days (max of 3 grams) until the client gets a warm or tingling sensation.
- Then reduce dose by 1 capsule - this is the client dose for future meals
5 cautions when using betaine HCL with a client
- Contraindicated with some drugs
- Can irritate sensitive tissues and corrode teeth
- Don’t empty capsules onto food or drink, take whole
- Don’t give on an empty stomach
- Smaller meals require a lower dose
5 symptoms of exocrine pancreatic insufficiency
- Bloating/belching/flatulence (1-2 hours after eating)
- Steatorrhoea (floating stools)
- Drowsiness after meals
- Food intolerances
- IBS symptoms
- Candidiasis
- SIBO
3 nutrients that are malabsorbed with exocrine pancreatic insufficiency
Zinc
B12
Folate
Other than chronic stress, list 5 causes of pancreatic insufficiency
- Damaged small intestinal wall (coeliac, IBD)
- hypochlorhydria (leads to reduced CCK
- cystic fibrosis
- chronic pancreatitis
- diabetes mellitis
- Xenobiotics - inactivate pancreatic enzymes
- SIBO (deconjugate pancreatic enzymes
- Dysbiosis
5 naturopathic recommendations for exocrine pancreatic insufficiency
- Don’t overeat
- chew properly
- avoid snacking
- Vagus nerve stimulation (activate parasympathetic NS)
- Pancreatic Enzyme Replacement Therapy
- Pancreatic enzymes
- Options for supplemental sources
- Lipase; proteases; amylase
- Animal-derived (pork pancreatin)
- PLant-based and microbe-derived - more advantageous
Advice to clients taking digestive enymes
- take with first bite of meal
- consider adding more during or at the end depending on meal duration (less than 15 mins - take all at the start; 15-30 mins take half at the start and half in the middle; more than 30 mins take a third at the start, middle and end.
*mimic endogenous secretion (secretion increases as more food is ingested)
Definition of bile insufficiency
bile synthesis and/or bile flow is compromised - affts ability to digest, absorb and utilise fatty acids from the diet
Signs/symptoms of bile insufficiency
- Steatorrhoea (consipation or diarrhoea
- Fatty food intolerance /nausea when eaten
- Bloating; flatulence; cramping
Stool test indicators of bile insufficiency
- high faecal fats
- Low/absent bile acids
4 Causes of bile insufficiency
- Low fat intake
- IMpaired liver function
- Gallstones/obstruction in bile ducts
- Obesity (reduced bile response after eating)
- Oestrogen dominance (increases cholesterol - which thickens bile)
- Gallbladder removal
- Coeliac
- Crohn’s
- Low HCL
Give 5 implications/complications of long-term bile insufficiency
- Fat soluble vitamin deficiency
- Hormones imbalances (poor oestrogen clearance)
- High cholesterol
- Compromised liver detox
- SIBO
- Gallstones
6 recommendations for a client with bile insufficiency
- Hydrate
- Avoid processed food
- Chew slowly
- Diaphragmatic breating
- Increase taurine and choline foods (bile components)
- Support liver detox (cruciferous veg and fibre)
- Eat choleretic and cholegogue foods
2 Amino acids found in bile and their food sources
- Taurine: seaweed; chicken thigh; clams; salmon
- Choline: kidney beans; broccoli; quinoa; eggs
4 choleretics
INcrease bile production
- Bitter melon
- Dandelion
- Artechoke leaf
- ACV
4 cholegogues
Increase bile flow
- artichoke
- bitter greens
- turmeric
- dandelion greens
- Role of the mucosal barrier of the GIT.
- Make up of the mucosal barrier
- 1st line of defence - provides a thick barrier against potential pathogens
- Mucus contains water; glycoprotein (mucins); IgA; antimicrobial peptides
Role of mucus for the microbiome
provides a site of adhesion and nutrient source for commensals
Consequence of a disturbed mucosal barrier are…
Bacterial can translocate; LPS can enter systemically and cause metabolic endotoxaemia
4 ways to support the mucosal barrier
- Dietary fibre (feed the bacteria or it will feed on the mucins)
- Increase polyphenols to feed commensals (green tea; blueberries; pomegranate)
- Use slippery elm, marshmallow; liquorice; flax
- Use seaweeds
what is the term for mucilaginous foods that support the mucosal barrier?
Mucopolysachharides
What are the implications of intestinal permeability?
How would you support a client with IP?
Increased LPS load and excessive immune reactions
- Glutamine (Supplement or cabbage juice)
- Zinc
- Vitamin A
- Bone broth (glycine)
Low Secretory IgA causes…
Low Secretory IgA is caused by…
increased risk of GI infection and SIBO
Chronic stress; NSAIDs; antibiotics
5 ways to increase SIgA
- Address stress
- Saccharomyces Boulardii
- Medicinal mushrooms
- Vitamin A
- Vit D3 (upregulates SIgA)
- Polyphenols
- Chlorella
- Probiotics and prebiotics
What vitamin is needed for the trasport of SIgA over the mucosal lining?
What vitamin upregulates the expression of SIgA
Vit A
Vit D3
Most common foods that cause intolerence
- Gluten
- Dairy
- Corn
- Soy
- Eggs
- Nuts
- Beef
- Pork
- Yeast
- Citrus
- Nightshades
- Chocolate
- Coffee
Outline the stages of an elimination diet
Stage 1: days 1-2 - detox
Wholefood diet (remove processed foods, caffein etc. and increase fruits and veg, water
Stage 2: days 3-14 - Elimination
As above PLUS remove all suspected foods for 2 weeks
Stage 3: days 15 + - Reintroduction
1 food at a time
Eat the food 2-3 times a day for 1-3 days
If there are symptoms, remove again.
Wait for symptoms to disappear then try the next food on the list
Keep a food that caused symptoms out of the diet for 3 months before challenging again.
5R protocol - REMOVE
What might be included under ‘remove’
- Foods that are a problem (dietary irritants; allergens; FODMAPS, histamine
- Toxins
- OTC drugs
- Pathogenic bacteria, viruses, fungi and parasites
Broad spectrum antimicrobial herbs
berberine
garlic
oregano
Antibacterials
Oregano oil
Berberine
Garlic
Neem
Anti-parasites
Wormwood
Neem
Pumpkin seeds
Oregano
Anti-fungals
Caprylic acid
Garlic
Grapefruit seed extract
Anti-virals
Olive leaf extract
Nano silver
Elderberry
5R protocol - REPLACE
What might be included under ‘replace’
- Stomach acid (digestive bitters; betaine HCL)
- Pancreatic juices (bitters; pancreatic enzymes; plant-based enzymes)
- Bile (choleretics; cholagogues; ox bile)
5R protocol - REINOCULATE
What might be included under ‘reinoculate’
- probiotics (fermented foods, supplements)
- prebiotics (FOS, chicory, leeks, onions)
5R protocol - REPAIR
What might be included under ‘repair’
- epithelial tight junction support (L-glutamine; N-acetyl glucosamine; quercetin; zinc; EFAs; bone broth, collagen
- Mucosal barrier (demulcent/mucilage: slippery elm, marshmallow, liquorice AND polyphenols to feed keystone species)
- Increase SIgA - S.Boulardii
- Reduce inflammation - turmeric
5R protocol - REBALANCE
What might be included under ‘rebalance’
Lifestyle choices:
- address stress
- Breathing exercises
- Exercise
- Eating habits
Antimicrobials for parasites/worms - how should you time this?
Will often need a second round to prevent eggs hatching
10 days on; 10 days off then repeat
OR
Treat for 4 weeks straight
What might the timings of SIBO anti-microbial treatment be?
A full 4 weeks and then potentially to repeat
How long should you use probiotics for and why
minimum 4 weeks - deficient microbes will take time to re-inoculate
What period of intervention is needed to food intolerences
6 weeks (time to repair gut wall before re-introducing)
6 causes of dysbiosis
- poor diet
- medications - antibiotics/OCP
- Chronic stress
- Low digestive secretions (HCL/Bile)
- C-section/not breastfed
6.Intestinal infections
C-section babies who are not breastfed have lower levels of which species?
This is associated with what in later life?
- Bifidobacteria
- Lactobacilli
Atopic disease in later life
Metabolic syndrome is associated with
- lower levels of….
- Increased levels of…
- poor ratio of which species
- Bifidobacteria and Akkermansia
- E-coli
- High firmicutes to Bacteroidetes
Pathogens that promote colorectal cancer
- campylobacter
- E.coli
Which pathogens arw associated with neurodegenerative disease?
- P.gingivalis (LPS detected in brain tissue)
Define metabolic endotoxaemia
a sublinical rise in LPS in the blood causing chronic low grade inflammation
3 chronic diseases associated with metabolic endtoxaemia
CVD
Diabetes
Autoimmunity
What do LPS interact with in the immune system?
Toll-like receptors (e.g. TLR4)
3 causes of increases in serum LPS
- dysbiosis
- mucosal degredation
- I.P.
5 recommendations for metabolic endotoxaemia
- Avoid alcohol/NSAIDs
- Increase fibre
- Avoid western or keto diet
- Focus on rainbows
- breathing and cold water therapy - to reduce LPS
- Reinolculate and repair barrier
- Support liver function (milk thistle, dandelion)
2 nutrients thay have an LPS blocking effect and how
- Spirulina
- Chlorella
TLR4 block
Butyrate-producing bacteria species - 2 e.g.s
- Roseburia
- Akkermansia
Definition of SIBO
4 main symptoms
Overgrowth of non pathogenic bacteria in the small intestine - most common cause of IBS
- Bloating and distention
- Abdominal pain
- Constipation/diarrhoea
- flatulence
SIBO: explain differences in symptoms depending on the dominant gas being produced
Hydrogen dominant gas - diarrhoea
Methane dominant gas - severe constipation
4 key clinincal indicators of SIBO
- Probiotics make symptoms worse
- Fibre make it worse
- Chronic GI symptoms following antibiotics
- Chromicly low iron with no other cause
- IBS following GI infection (PI-IBS)
- Coeliac patient with lack of improvement following strict gf diet
3 medications that can cause SIBO
antibiotics - dysbiosis
opiates - slow motility
PPIs - low HCL
SIBO aetiology - 3
- hypochlorhydria/low HCL (why?)
- chronic stress
- chronic PPI use
2.Low SIgA
- Chronic stress
- Adhesions from surgery/scar tissue
- Hypothyroidism
- Poor oral health
- Ileocaecal valve dysfunction
Role of stress in SIBO aetiology
Prolongued stress
- shuts of MMC
- reduced HCL
- Lower SIgA
Explain how acute gastritis can trigger SIBO
- Pathogenic bacteria release CDT (Craft Design Technology toxin)
- CDT - mollecular mim
