MNT Gastrointestinal disorders Flashcards

Question

SWIFT PROTOCOL

Answer 1

Start with the basics work with differentials integrative care for stress foods that fit, but not unnecessary restrictions. Top to most effective, least invasive

Answer 2

Testing - baking soda ¼ tsp baking soda with 4 oz water. Drink first thing in the a.m. Time onset of burps

Answer 3

1, 350-750 mg capsule of HCl with protein-containing meal for 48 hours. No reaction? 2, 350-750 mg capsules with protein -containing meal. Continue up to 5 caps until you get burning, heat, etc. Stay with that dose as you eat - note that smaller meals may require less . . . Remember SWIFT

Answer 4

Anemia: Feeds high in Vitamin B12 (megoblastic anemia possible in SIBO) Foods high in iron Meg(Klaire Labs chewable iron Chelate) 2. Fat soluble: vitamin A, D, E, (K may be elevated) 3. water soluble: B12, Thiamine, nicotinamide (folate may be elevated) 4. Predisposing factors: use MNT to support

Answer 5

Anemia Vitamin D, E, A Vitamin B12, thiamine predisposing factors K is often high Folate is often High Safety and necessity of special SIBO diets HX of ED Family Hx of ED current anxiety, OCD ability to follow diet GUT BRAIN AXIS stress traumatic brain injury vagal tone sleep motility Migrating motor complex Food Hygiene Hypochlorhydria/PPI Resistant starch fiber ferments prebiotics Binders: Charcoal clay modified citrus pectin Immune/LSP support IgG SBIs BIOFILM DISRUPTORS: specific enzyme blends N SEED: probiotic (Caution) WEED: presence of hydrogen producing bacteria: streptococcus, Escherchia coli, Bacteroides, staphlycoccus, clostridium , Micrococcus, Klebsiella pneumoniea, preptstreptococcus, -presence of methane producing bacteria/archaea: Methanobrevibacter smithii -presence of sulfur producing bacteria: Desulfovibrio Reintroduce foods: Follow plan guidelines, Ensure sustainability: reconsider nutrition reconsider sleep reconsider movement reconsider stress practices TAPER SUPPLEMENTATIONS symptom relief last Make long term plan

Answer 6

NEED: FIRST APPROACH; Approach: SCD, GAPS, low FODMAP NEED: First Approach Approach: Cedars-Sinai Diet (C-SD), NEED: treatment resistance; Approach: SSFG (Siebecker) NEED: treatment resistance; Exclusive Enteral Nutrition, Polymeric, peptide, or elemental. NEED: treatment resistance; Approach: Sibo-Bi phasic (B-PD)

Answer 7

a. Gut brain axis: >Eat with the client in session, >frequent appointments >Referral to therapist >Referral to club/social groups >Encourage social eating >TBI protocols when warranted MEg: >Happy inside APP & virtual services > Nerva > Safe and sound protocol >Accessing the healing power of the Vagus >Nerve by Stanley Rosenberg

Answer 8

Ideally 5 hours between meals, clear liquids inbetween,

Answer 9

Are they eating and bunch prebiotic, fiber rich foods that are feeding the overgrowth.

Answer 10

Low stomach acid If the client is on the PPI, you should not add HCL. If not on a PPI, you can add bitters or HCL. as long as the client doesnt have GERD, Barrett's esophagus or a stomach ulcer. but may be warranted for SIBO for hypochlorhydria. But also look for root cause of hypochlorhydria- which is often stress.

Answer 11

A. Binder: charcoal, clay, modified citrus pectin >quicksilver ultrabinder, Biocidin GI Detox B. Immune/LPS support: Serum bovine IgGs >Orthomolecular SBI protect >Microbiome Labs MegaMucosa and IgG2000 C. Biofilm disruptor: specific enzyme blends, NAC, curcumin >Klaire labs interfase >Klaire labs interfase plus (caution with anemia)

Answer 12

Seed: Bacillus based probiotics MIcrobiome Labs megaspore Weed Hydrogen: certain herbals, garlic, neem, oregano >Biocedin liquid capsules, LSF, metagenics candibactin AR/BR Weed Methane: Bitter Orange, bile acids, wormwood, quebracho, horse chestnut, >Atrantil Weed Sulfur: Bisthmuth, green tea, curcumin, Molybdenum + temporary elimination of aliums and cruciferous. > Priority One Biofilm Phase 2 Advanced

Answer 13

Welcome, improve and Feed interventions first Symptom interventions last Food reintroduction: follow reintroduction guidelines.

Answer 14

Celiac disease is an autoimmune disease that is triggered through consumption of gluten (a protein in wheat, rye, barley). Antecedents: Increased risk with family hx of celiac, type 1 diabetes, Down syndrome. Medical Testing (recommendations from Dynamed): 1. Use IgA antitissue transglutaminase antibody (tTG) as the initial test in patients 2. IgA or add immunoglobulin G (IgG)-based deamidated gliadin peptides (DGPs) if very low IgA anti-tTG levels suggest IgA deficiency 3. IgA anti-tTG and IgA- and IgG-DGPs in children < 2 years old If IgA tTG > 10 times upper limit of normal, consider testing endomysial antibody (EMA) and human leukocyte antigen (HLA)-DQ serotyping to diagnose celiac disease without endoscopy and biopsy. 4. Obtain HLA-DQ2 or DQ8 genotyping to rule out celiac disease in selected situations if other testing is indeterminate 5. Obtain an upper endoscopy with small-bowel biopsy (with multiple biopsies from distal duodenum and duodenal bulb) to confirm the diagnosis in patients with suspected celiac disease. 6. Consider testing for nutritional deficiencies with hemoglobin, iron, folate, vitamin B12, calcium, and vitamin D levels. Bone mineral density tests for osteoporosis Diet: 1. Life-long gluten free diet - be sure to complete all blood testing and biopsies BEFORE starting gluten restriction 2. Monitor oat consumption for oat intolerance or cross reactions to gluten. 3. Assess for deficiencies of: folate, iron, vitamin B12, vitamin D 4. Avoid lactose initially after diagnosis, can add back once gut is in better shape.

Answer 15

Celiac disease is a chronic autoimmune disease 1 in 100 people worldwide have celiac disease, or 3 million Americans. 80% of Americans with celiac are undiagnosed. Reaction to gluten only - found in wheat, rye, barley. Do not remove all grains only gluten-containing ones. Oats can be contaminated - GF certified only Family hx matters: people with first degree relative with celiac have a 1 in 10 chance of developing. Incidence of celiac in children = Crohn’s, Ulcerative Colitis, and Cystic Fibrosis combined. Celiac disease can affect every organ in your body. Lifelong, gluten free diet is the ONLY treatment. Approximately 20% of people with celiac disease do not respond to the gluten-free (refractory celiac)

Answer 16

Diagnosis typically takes 6-10 YEARS, during which time the following diseases correlated with undiagnosed celiac can develop: ● intestinal cancers ● type 1 diabetes ● osteoporosis ● thyroid disease ● multiple sclerosis ● Infertility and miscarriage ● anemia More than 300 symptoms associated with celiac, BUT 20% of people asymptomatic Even if they are asymptomatic, they are at risk for lifelong complications

Answer 17

Blood test, endoscopy. Commonly co-occurring diseases include: microscopic colitis, IBD Lactose and/or fructose intolerance Malabsorption in celiac often comes with deficiencies in: ● Iron ● Calcium ● Magnesium ● Zinc ● Folate ● Niacin ● Riboflavin ● B12 ● Vitamin D

Answer 18

Incidence and risk: 2-20%, depending on the study Risk: malnutrition (duh), as well as T-cell lymphoma and small bowel adenocarcinoma. Getting “Glutened” ● Supplements and Medications (inactive ingredients) ● Dental products (toothpaste, rinse, even bands used for braces) ● Lipstick and make up ● Communion wafers ● Play dough ● Stamps (lickable)

Answer 19

1. Support: social wellness, positive mood, movement, sleep, gentle nutrition, hygiene, food life skills, knowledge, self-compassion, stress reduction 2. Welcome: supportive gut bacterial balance through use of prebiotic/probiotics, antimicrobials/parasitics, fiber-filled foods, SCFA, and dietary interventions 3. Improve: digestive competency with HCL, digestive enzymes, bile, fiber, vagal stim 4. Feed: the gut with supportive nutrients including zinc, Vitamins A and D, glutamine, cabbage juice, collagen, NAC, marshmallow, etc. 5. Taper: reintroduce any foods that were removed, ensure sustainability, and work to bring down supplementation to most effective, least invasive.

Answer 20

Calcium Signs of deficiency: Hypotension, prolonged QT interval, distal extremity, parasthesias, Chvostek sign, Trousseau sign, muscle cramps, tetany, seizures Risk factors: Vitamin D deficiency, decreased PTH activity,2 corticosteroid use Biochemical Assessment: Serum calcium does not fluctuate with changes in calcium intake Recommended Replacement for deficiency: Gender and age specific: *9-18 yrs: 1300 mg *19-50 yrs: 1000 mg *51-70 yrs: 1000 mg (male), 1200 mg (female) *71+ years: 1200 mg

Answer 21

Cognitive decline, cardiovascular disease, bone fractures; megaloblastic anemia with macrocytosis; glossitis, constipation, diarrhea; hand/feet paresthesia; confusion, poor memory Risk Factors for deficiency: Crohn’s disease affecting the terminal ileum; ileal resection >20cm; significant gastric resection; small intestinal bacterial overgrowth (SIBO); vegetarian diet Biochemical assessment: High serum Methylmalonic Acid, low plasma or serum B12, elevated MCV Recommended replacement for deficiency: oral B12 supplementation >1000 mcg daily.Prophylaxis: IM B12 1000 mcg monthly with >60cm ileum resected

Answer 22

signs of defiency:Hypocalcemia, osteomalacia, osteoporosis risk factor for deficiency: Malabsorptive disorders, small intestinal bacterial overgrowth (SIBO), corticosteroid use Biochemical assessment: 25-(OH)D <20 ng/mL deficiency; 25-(OH)D <21-29 ng/mL insufficiency Recommended replacement for deficiency: If level<20: 50,000 IU D25 or D3 for 12 weeks; recheck levels and continue supplementation if still deficient. Maintenance dose of 1500-2000 IU/d D3;7 higher maintenance doses of 3000-6000 IU/d are recommended for patients on glucocorticoids, anticonvulsants, those with malabsorption BMI>30, or in those with small bowel involvement.

Answer 23

SOD: Megaloblastic, macrocytic anemia; diarrhea, smooth, sore tongue; weight loss; nervous instability; dementia Risk factor for defiency: GI resections; patient on restrictive diet; use of sulfasalazine, methotrexate, cholestyramine; achlorhydria; small intestinal bacterial overgrowth(SIBO) Biochemical assessment: Low plasma or serum folate (will be elevated if +SIBO), elevated MCV and homocysteine, low red blood cell folate Recommended replacement for deficiency: 1 mg folic acid daily

Answer 24

1. SOD: Microcytic, hypochromic anemia; tachycardia; poor capillary refil, fatigue, sleepiness, headache, anorexia, nausea, pallor, impaired behavioral performance 2. Risk factor for deficiency:GI bleeding, UC, achlorhydria, small intestinal bacterial overgrowth (SIBO) 3. Biochemical assessment: Hb 10-12 g/dL (women), 11-13 g/dL (men); Serum ferritin <100 ng/mL, transferrin saturation <20%, elevated transferrin receptor levels 4. In inactive IBD/normal CRP: 100 mg oral iron daily in divided doses. Additional vitamin C may help enhance iron absorption. In active IBD, chronic iron deficiency anemia, Hb <10 g/dL (women), <11 g/dL men: consider parenteral iron.

Answer 25

Signs of defiency:Neuromuscular hyperexcitability, latent tetany, frank seizures,arrhythmias Risk factor for defiency:Chronic or severe acute diarrhea, short gut Biochemical assessment: Low serum magnesium 150 mg elemental Mg four times daily

Answer 26

signs of deficiency: Seborrheic dermatitis, microcytic anemia, confusion, depression, angular stomatitis, glossitis, cheilosis Risk factor for deficiency: Restrictive diets, poor oral intake, corticosteroid or isoniazid use Biochemical assessment: Low mean plasma pyridoxal-5-phosphate (PLP) concentration 50-100 mg/day OR 10 to 20 mg/day IM or IV for 3 wk; then 2 to 5 mg/ day ORALLY for several

Answer 27

Signs of deficiency: Inadequate growth, acrodermatitis enteropathica, hypogonadism, impaired night vision, anorexia, diarrhea alterations in taste and smell, alopecia, impaired wound healing Risk factors for deficiency: PPI/H2 blockers, protein deficiency, malabsorptive disorders, diarrhea, fistulizing disease; vegetarian diet, Biochemical assessment: Low plasma or serum zinc Recommended replacement for deficiency: 50 mg elemental zinc for 10 days. Caution copper deficiency for those on long term zinc supplementation.

Answer 28

44% of SIBO reoccurs Symptom relief: Assess for Anemia, Vitamin D, E, A, Vitamin B12, Thiamine, Predisposing factors, K is often high, Folate is often high, Predisposing factors: Hypothyroid, IBS, IBD, chronic pancreatitis, celiac disease, T2DM, gastroparesis, medications (opiods, anticholinergics, PPIs), hypochlorhydia, ETOH abuse, gastric bypass, Safety and Necessity of Special SIBO Diets: Hx of ED, Family history of ED, Current anxiety, OCD, Ability to follow diet,

Answer 29

Fat: 1. Deconjugation of bile acids resulting in decreased bile acids available for micelle formation. 2. Production of toxins such as lithocholic acid that may directly inhibit absorption. Carbohydrates: Production of toxins such as lithocholic acid that may directly infhibit absorption. 2. decradation of sugars by bacteria 3. Impaired acitivity of brush border disaccharidase and hydrolase Protein: Production of toxins such as lithocholic acid that may directly inhibit absorption. Vitamin B12: Consumption of B12 by bacteria. 2. Inhibition of B12 absorption in the terminal ileum. Vitamin A, D, E: Deconjugation of bile acids resulting in decreased bile acids available for fat absorption.

Answer 30

1. Failure of gastric acid barrier: a. atrophic gastritis b. Hypochlorhydria c. gastric bypass d. proton pump inhibitors 2. Failure of small bowel clearance a. Primary visceral neuropathy or myopathy b. Connective tissue disease (scleroderma, polymositis) c. Amyloidosis d. Gastroparesis E. Radiation enteropathy F. Paraneoplastic syndrome G. Medications (opiods, anticholinergics) 3. Small bowel anatomic alteration: a. short bowel syndrome b. small bowel diverticulitis c. small bowel strictures or fistulas d. small bowel obstruction e. Blind loops (Roux-en Y) f. ileocecal valve resection 4. Immunodeficiency: a. IgA deficiency b. combined variable immune deficiency c. T cell Deficiency 5. Multifactorial a. irritable bowel syndrome b. Cirrhosis c. Chronic pancreatitis d. obesity e. Cystic fibrosis f. celiac disease g. Diabetes mellitus h. hypothyroidism

Answer 31

Anemia: Foods high in vitamin B12 (megoblastic anemia possible in sibo), foods high in iron. +Klaire labs chewable iron chelate Fat Soluble : Foods: Vitamin A, D, E (K may be elevated) Water soluble: Foods: B12, Thiamine, nicotinamide (folate may be elevated) PRedisposing factors: USe MNT to support NEED: First approach a. SCD, GAPS, low FODMAP b. Cedars- Sinai Diet (CSD) NEED: Treatment resistant a. SSFG (Siebecker) b. Exclusive, Enteral Nutrition, polymeric, peptide, or elemental

Answer 32

Gut BRain Axis: Stress, Traumatic brain injury, Vagal tone, Sleep, motility, migrating motor complex. Food Hygiene: >Hydrochlorhydria/PPI >Resistant starch:+ >Fiber + >ferments+ >prebiotics + + may be problematic temporarily as can increase bacterial proliferation NEED: Gut Brain Axis: Eat with cleint, frequent appointments, referrals to therapist, clubs, social groups, Encourage social eating, TBO protocols when warranted. NEED: Migrating motor complex: 5 hours between meals, clear liquids ok. NEED: If client is on PPI, do not add HCL . If NOT ON PPI, possible HCL as long as no risk of Barrett's esophagus, stomach ulcer. Food Hygiene: Are they eating prebiotics, fiber rich foods? May be feeding the overgrowth.

Answer 33

Binders: >Charcoal >Clay >Modified citrus pectin Immune/LPS support: IgG SIBIs Biofilm disruptors: Specific enzyme blends NAC curcumin SEED: Probiotics (caution) *Bascillus based (Microlabs Megaspore) WEED: PResence of hydrogen producing bacteria; strep, Ecoli, Bacteroides, Staph, Clostridium, MIcrococcus, Klebsiella, Peptostreptococcus. ** Certain herbals, garlic, neem oregano ( Biocidin liquid capsules, LSF MEtagenics Candibactin AR/BR > presence of methane producing bacteria/archea: MEthanobrevibacter **Bitter orange, bile acids, wormwood, quebracho, horse chestnut (Atrantil) > PResence of sulfure producing bacteria: Desulfovibrio. ** Bismuth green tea, curcumin, molybdenum + temporary elimination of aliums and cruciferous (A. Biocidin Broad Spectrum liquid-titrate slowly; B. Brain Octane Oil (contains caprylic acid), titrate c. Metagenics Candibactin- AR/BR 1. Reintroduce foods according to whatever plan you are using. 2. Ensure sustainability 3. Taper supplementation. Taper: Welcome, improve and Feed interventions First symptom interventions last

Answer 34

ASSESS: Low Hemoglobin <12 g/dL Women <13 dL Men >Low Ferritin <30 ng/ml >Relationship to food Dietary Triggers: >IBS as well as IBD >Fat malabsoprtion >Insoluble Fiber >Gluten >Flares >Treatment Resistance

Answer 35

ANEMIA: -High iron foods (if client is anemic, you must supplement iron, food is not enough) 30-100 mg/day REactivity to FODMAPS: -Low Fodmap Adults: AIP and SCD Flare: Low residue, Exclusive Enteral Nutrition, Polymeric peptide, or elemental Pediatrics: SCD Treatment Resistance in Pediatric: Exclusive Enteral Nutrition, Polymeric, Peptide, or elemental Crohn's Disease: CDED Fat Maldigestion: Low Fat In Remission: MEditerranean

Answer 36

Th1 and Th17 condition with elevated production of IL-12, IL-23, IFN-y, IL-17

Answer 37

Gut Brain Axis: Stress, mental health, QOL, Vagal tone Food Hygiene: Dietary Diversity, Resistant starch, color in foods, omega's, Fiber, Ferments, Prebiotics GUT BRAIN AXIS: stress contributes to flares. Data on Vagal Stim. Food hygiene: Watch Macros (protein and fat) and bioactive compounds such as ferments, omega's : May be limited due to sumptoms.

Answer 38

TH2 and Th9 condition with increased production of IL-13, IL-5, IL-9.

Answer 39

1. Look up everything, may be contraindicated 2. repair the gut lining 3. consider colostrum or IgG support when indicated 4. BE curious about food intolerance 5. consider anti-inflammatories Contraindications: Melatonin (worsens clinical coarse) Glutamine (Be aware: may be harmful) Repari Gut lining: Phosphatidylcholine in UC (improves mucosal lining) & Bone broth. Immune/LPS support: Serum Bovine IgG , probiotics, Food Intolerance: Repair gut lining, then consider elimination Anti-Inflammatories: >Curcumin >Boswellia, >Omega's >saffron (to reduce disease severity) Taper: reintroduce foods: make a plan, reintroduce 3x. repeat failed foods. -Welcome, improve and feed interventions first. -symptoms interventions last.

Answer 40

Feed: Prebiotic foods: Garlic, onions, bananas, apples, oats, asparagus, resistant starches, such as cooked and cooled rice and potatoes. Supplements: Psyllium and inulin in UC FOS in CD, Seed: Yogurt, kefir, sauerkraut, tempeh, kimchi, miso, kombucha, pickles. Probiotic supplements Weed: Posemary, sage, basil, oregano, parsley, olive leaves, nutmeg, citrus (anti-microbial herbal supplements)