GI Flashcards
What is the signficance of Lipopolysaccharide Bacterial Endotoxin?
Major indicator of leaky gut
when WBC goes through phagocytosis, endotoxin is released
Can be measured in blood
What is a bacterial endotoxin
marker of transcellular leaky gut
connects gut to systemic inflammatory problems
What is Diamine Oxidase
marker of leaky gut
enzyme made in microvilli
What is histamine intolerance and how does it affect DAO
results from disequilibrium of accumulated histamine and capacity for histamine degradation- reduced Dao activity is a trigger
What factors contribute to histamine excess
allergies mastoycytosis bacteria GI bleeding Ingestion of histidine or histamine by food/alcohol DAO deficiency
Which tissue produce DAO
small intestine
colon
placenta
kidney
What is gut brain axis
Bidirectional relationship- influence each other
How does gut influence brain and vice versa
regulation of mucosal immune system GI motility Epitherlial barrier function Digestive and host metabolism support Prevention of colonization by pathogens
What are Lipopolysaccarides
molecules present on surface of gram-negative bacteria that elicit a strong immune response
What are cytokines
messengers used by immune system to communicate with itself and other parts of CNS
What is the gut barrier’s function
tight junctions important as outside world goes in located between cells prevents paracellular flow 50 different proteins
What triggers reduced barrier function
Stress- physical and mental
Environment- chemical- medications and pollution
Dietary- Gluten, Dairy, food sensitivities, Alcohol, Poor diet
How does stress weaken the gut barrier
activates autonomic nervous system
primarily activates the sympathetic nervous system
SNS displays mild anti-inflammatory prosperities in the gut
Stimulates Secratory IgA
What is Secratory IgA
antibody produced in mucosal lining and role in immunity
How does SIgA help immune system
neutralizes pro-inflammatory antigens
down regulation is associated with stress and negative repercussions
Immunosuppressive effects of stress on SIgA can be attenuated by activating peroxisome proliferator activated receptors
What are some diet considerations regarding gut barrier
High fructose has negative role
Western diet in of itself can increase Lipopolysacharides
General Western diet not good for health of gut
How do nutrient deficient play a role
Vitamin A and magnesium- Retionic acid plays major role in experts of genes related to epithelial barrier and tight junction
Zinc- deficiency directly breaks down tight junctions and increases permeability
Vitamin D- huge in mucosal barrier function: preserve junction complexes and stimulate renew of epithelial cells, modulate immune function
How does GI induced inflammation affect Central Nervous system
mood disturbances and fatigue can be induced by LPS
What 2 disorders have been shown to be higher in LPS
depression and anxiety
What factors contribute to increased LPS
Obesity
High insulin, triglycerides and Cholesterol
Diabetes
What does LPS induced cytokines cause?
altered neuronal activity in amygdala
exitoxicity in neuron
increase in activty
How are inflammatory cytokines formed
systemic cytokines induce the production of immflamatoy cytokines in CNS via microglial activation
What happens if microglial is overactivated
potential for neurodegeneration
How do altered cytokines alter neurochemistry
cytokines act on central sites where blood brain barrier is weak or causes breakdown of blood brain barrier
Cytokines transported by selective transports by BBB
act on peripheral nerves that send information to CNS
eventual changes in mood, behavior and cognition
How to control this process and keep in appropriate range
reduce SIBO reduce endotoximia reduce inflammatory cytosine production Reduce intestinal barrier function Improve BBB integrity
What is successful treatment for those with altered neurochemistry
Exercise: 30-60 mins 4x a week- most effective Reduce food sensitivities Optimize gut health Stool tests Supplements
How to reduce cytokine production
Vitamin D
SOD- superoxide dismutase
Omega 3
Lipoic Acid- BBB stabilizer
How does zonulin affect autoimmunity
opens spaces between cells of intestinal lining
Leaky gut present- spaces allow larger protein molecules to get into blood stream
Body is prime to react to those proteins
Causes of intestinal permeability
IBD NSAID therapy SIBO Celiac Protzoal infections Food Allergy Chronic Alchohoism Diarhea Exercise Increasing age Nutritional Depletion
Factors contribute to autoimmune disease
Genetics
Environmental factors
Gut dysbiosis
What percent of genetics play a role in autoimmunity
30%
What environmental factors play a role in autoimmunity
- )Infections and toxins
- )Smoking
- )Chemcial toxicants: aluminum, silicone Tobacco, Glyphosate, Bisphenoal A
- ) Heavy Metals: mercury, infectious agents
- ) Emotional stress
- ) Drugs
- ) elevated lipid profile
How does the gut affect autoimmunity
foods have gone transformation: new strain of grain- wheat, rice, soy and corn more GMO in US than rest of the world more chemical use Dairy cows injected with hormones chemicals in food artificial sweeteners
what is a clean diet
local and home grown avoid refined oil limit alcohol and caffeine avoid allergens avoid toxic food- farmed atlantic salmon, high mercury fish, non-organic dairy and eggs, dirty dozen fruits and veggies- organic as possible sugar free GF, DF, non-GMO
What is the Enteric Nervous System
primarily responsive for Motility, ion transport and blood flow in GI
has more neurons than spinal cord
What are the laws of the intestines
parastolic reflex vast chemical warehouse- every class of neurotransmitter found in the brain is in the gut
What percent of serotonin is found in the gut
95%
What are Peyer’s patches
regulatory site for defense of foreign invaders in GI
What is immunoglobulin A
antibody playing critical role in immune response
provides first response to antigens ingested
Where is immunoglobulin A found( SigA)
in mucosal secretion
Are SigA inflammatory?
No, signal help from igG and IgE and then inflammation begin as phagocytes are called in and produce inflammatory response
Which system is responsible for sIgA?
Adrenals- specifically cortisol
Why to do stool testing
Look for beneficial bacteria as well as any dysbiosis, and other issues within the gut
What are some bacteria pathogens commonly found in stool testing
H. Pylori
C Diff
Campylobacter
E coli
what does a stool test with below levels mean?
increased susceptibility to pathogenic bacteria
Increased toxic enzyme exposure
What are interventions for pathogens found in stool testing
ID cause of depressed bacteria
Provide probiotic support- lactobacillus acidophilus, bifidobacterium
What are common digestive markers
Elatase
Triglycerides and incomplete fat digestion
Putrefactive SCHA- signifies undigested protein if high
What is elastase
Pancreatic enzyme- typically seen with disorders such as diabetes, gallstone, and osteoporosis
What markers are in gut immunology
Eosinophil Protein X- reflects inflammation and tissue damage
Calprotectin- elevated with IBD, IBS, Cancer, Food allergies
Fecal SIgA- immune systemic reaction
Anti-gliadin- gluten sensitivity
Other markers on stool test include
PH levels
Occult- looks for GI bleeding
RBC count
Color
What factors signify GI inflammation
Lactoferrin- iron binding- IBD not in IBS
WBC- general inflammtion
Mucus- acute GI inflammation
What are effects on GI with lots of pathogen
Depletion of B12 and amino acids
Short circuit digestive enzyme
increases GI infection potential
Encourages GI inflammatory disease
What factors contribute to disrupted flora
too many sweets and carbs overuse antibiotics stress poor digestion inflammation infection exposure to toxins lowered immune other unknown causes
How to diagnose issues from stool testing
careful history
specific testing
organic acid testing
look for yeast, bacteria and parasites
Goals for treatment of issues found from stool testing
restore normal flora
provide nutrients that will help
reduce toxic exposure
increase antibodies in GI tract SIgA
What are common parasites and their presentation
- ) Blasotocytis Hominis- constipation, poor absorption, fatigue nervous, skin disorder
- ) Dientampoeba Faragilis- Diarrhea, fatigue, abdominal bloating
- ) Giardia- symptomatic to severe diarrhea
- ) Taenia( tape worm), asymptomatic- GI complaints vague- B12 may be decreased
How do parasites affect the body
products emitted by bugs destroy and cause malabsorption
What are organic acids and why test
measure acids in urine
cover microbial byproduct
provide good info for nutritional assessment, GI function, neurotransmitters and other
What are recommended labs
Genova
Metametrix- atlanta
What is specific about Benzoate
preservative in packaged foods- pickles, lunch meats
natural ingredient in cranberries
glycine and B5 required to remove from body
Specifics for Hippurate
made as liver metabolizes bacteria
when see high levels= bacteria overgrowth
How to remove excess benzoate
decrease sugar
increase prebiotic and probiotic
How to remove excess hippurate
rule out high benzoate foods
increase Glycine
Increase B5
Specifics for P-Hydorxyphenylacetate( HPA)
malabsorption of tyrosine due to low HCL in stomach
dysbiosis- rule out other anaerobic bacteria
lactose intolerance
malabsorption of phyenyalaine due to low HCL
How to treat HPA
introduce probiotics, antibiotics- herbal and prescriptive and decrease sugar
What is D-Lactate
organic acid that is neurotoxic
shows when lactobacillus audiophilus is too high- indicates iniability to absorb carbohydrates
What is Citramalic Acid
metbolite of yeast- overgrowth of bacterial pathogens, clostridia
How to treat high citramalic acid
antifungals, anti-yeast diet, probiotic, anti-yeast products
What is Indoleacetic Acid- DHPPA
high with clostridia
How to treat DHPPA
pre and probiotics, antibiotics, incorporation natural antimicrobials, decrease sugars and look for reasons for malabsorption
What is Phenylacetic acid( PAA)
malabsorption of phenylalanine due to low HCL
possible gastric hypochlorohydria
suspect clostridia
How to treat PAA
antibiotics, antimicrobials, pre and probiotics, decrease sugar, investigate possible malabsorption and mucosal support
What is succinct acid
intermediate of citric acid cycle
key component of iron(low), riboflavin(L)- iron and riboflavin will show up low
How to treat high succinic acid
correction of malabsorption, look for GF sensitivity, mucosal support agents, increase iron and riboflavin
what is indoleacetic acid reason high
caused by unabsorbed tryptophan- from possible hypocholohydria
How to treat high indoleacetic acid
increase HCL, look at why malabsorption and mucosal agents
What causes high Tartic Acid
tartaric acid containing foods such as grapes, raisin and wine Arbainose rich foods possible joint inflammation Hyaluronic acid yeast
How to treat high Tartic Acid
Antimicrobials, decrease sugar
What are P-Hydorxybenzoate and P-Hydroxyphenylacetate
Made from antibiotics, foods
How to treat P-hydroxybenzoate and P-Hydroxyphenylacetate
pre and probiotics, natural micbrocial complexes
What is high Indican acids
Poor protein digestion( tryptophan)
Bacterial overgrowth in small intestine( SIBO)
Possible not enough enzymes, parasites, fungal infections, indigestion of food, hypo motility
How to treat high indican acids
ID reasons for protein malabsorption
INtroudcue lactobacillus
What is Tricarballylate
Connects to Magnesium, calcium and zinc- binds to these minerals and blocks them
How to treat high tricarballylate
introduce pre and probiotics
What is the Intestinal barrier function test
gold standard in evaluating intestinal mucosa
What does the internal barrier function test look at?
dietary proteins
enteric yeast- like candida
enteric aerobic bacteria( Esherichia coli and E. enterococcus)
enteric anaerobic bacteria( bacteroids Fragilis and Clostridium)
Should look at these proteins and antigens and body will process accordingly, but when barrier damaged body unable to process and leaks into system
Why do we test for mucosal barrier?
we use saliva and looks at functional status and whats compromising the environment, toxins, yeast, food sensitivities
Posible outcomes for testing for mucosal barrier
Normal levles
Microflora imbalance- aerobic/anaerobic- should be 1:1
Food allergy or intolerance
Gut barrier Dysfunction
Immunodeficiecny
Test permeability- not as sensitive as intestine barrier function
What is HPHPHA
an abnormal phenylalanine metabolic of clostridia- found in GI tract, urine samples from people with autism dn schizophrenia
What is the structure of HPHPHA
benzine ring with 6 horizontal round- has hydro group and propionic acid and phenol group
only produced by clostridia bacteria
How is Clostridia Dificille spread
by alcohol hand wash in hospitals
What are the properties of clostridia bacteria
spores look like tennis rockets
strict anaerobic-die when exposed to O2
cause tetanus, diarrhea and botulism( food poisoning)
forms spores that are highly resistant to heat and antibiotics
100 species of clostridia in GI tract- not all pathogenic
What are clostridia species that produce HPHPA precurose
C. Sporogenes C. Boulinum C. Mangenoti C. Ghoni C. Bigermentans C. Caloritolerans
How does clostridia affect brain chemistry and behavior?
produces HPHPA
chemicals inhibit and deactivate enzyme dopamine beta hydroxylase so that dopamine builds up and becomes neurotoxic- which results in abnormal repetitive stereotypical behavior and agression
How to treat increased HPHPA
Vancomycin- oral Flagyl Lactobacillus acidophilus- or rhamnosus IV glutathione or NAC High protein diet( phenylalanine, tyrosine may increase production of toxic clostridia)
What is the definition of SIBO
condition abnormally large numbers of bacteria are present in the small intestine leading to impairment of digestion and absorption
What are common symptoms of SIBO
bloating/abdominal Gas Pain and cramps Constipation/Diarrhea or both Heartburn- methane Nausea Leaky Gut- food sensitivities Neurological disorders Malabsorption
What disease are associated with SIBO
IBS/IBD GERD Celiac and GS Autism Firbormyalgia- CFS Interstitial Cystitis Restless legs Acne Rosacea Diabetes Hypothyroidism Scleroderma NASH Cirrhosis and hepatic encephalopathy Diverticulitis
What is a key indicator for SIBO
when a patient reports dramatic transient improvement in IBS/GI symptoms after ABX Rx
Microbes most commonly overgrowth in SIBO
Commensal Anaerobes- Bacteroids, Lactobacillus, Clostridium
Commensal Aerobes- Streptococcus, Escherichia Coli, Enterococcus, Staph, Lebsiella, Proteus Mirabilis
What are preventative factors for SIBO
enzymes
GALT Immunity
Which gasses are present with SIBO
Hydrogen, methane and hydrogen sulfide- flora produce H2 and CH4- not made by humans- excess gas causes symptoms
Which breath test is most accurate for diagnosing SIBO
Lactulose Breath test as it is 100% food for organisms and can’t be absorbed in the body
What does the SIBO breath test do
Measure hydrogen and methane in SI diffused into blood and exhaled after drinking sugar solution
What is a positive SIBO breath test result
within first 2 hours:
Hydrogen- 20ppm over lowest preceding level
Methane=12 ppm over lowest preceding level
Combined=15 over lowest preceding level
What is one other non SIBO condition with elevated methane
Methane induced constipation- CH4 levels greater than 2ppm at any time during lactulose test- 3 or above with major symptom of constipation= a cause for treatment
What does the prep for SIBO breath test consist of
diet- no carbs and very specific foods
off antibiotics for 2 weeks before re-test unless doing treatment
Ideally no PPI for several days prior
lo laxatives, high dose magnesium, vitamin C for 4 days before test
Treatment goals for SIBO
reduce bacteria/archaea
detox and support BB healing
Prevent relapse
Treatment options
If positive test: Diet- Elemental Diet Prescription Antibiotics Herbal Antibiotics
How to prevent SIBO
Diet Prokinetics improve possible hypochlorohydria improve illeocecal valve function Treat pancreatic insufficiency
