Mucosal Barrier, Elimination, 5R Flashcards
Mucosal barrier
Mucus covering the entire GIT provides a thick barrier between the immune-stimulating contents of the outer world and the multitude of immune cells in the gut wall (1st line of defence).
Mucus contents
Mucus contains water (96–98%), glycoproteins called mucins, IgA and anti-microbial peptides such as α and β defensins.
Mucus provides an adhesion site / nutrient source for commensals.
Damage to mucosal barrier
In ulcerative colitis, it has been observed that the inner mucosal lining becomes permeable = large amount of bacteria in close contact with host tissues = inflammation
In ulcerative colitis, it has been observed that the inner mucosal lining becomes permeable = large amount of bacteria in close contact with host tissues = inflammation
Supporting the mucosal barrier:
- Optimise fibre
- Polyphenols (resveratrol)
- Mucopolysaccharides such as slippery elm,
marshmallow root, liquorice and flaxseeds.
Intestinal tight junction permeability
- Intestinal tight junction disassembly contributes to ↑ LPS load and excessive immune reactions.
Support the intestinal epithelial barrier
‒ Glutamine —supplemented or from food, e.g., cabbage juice, spirulina, asparagus.
‒ Zinc carnosine, vitamin A and N-acetyl glucosamine.
‒ Bone broth (rich in glycine).
Secretory IgA
Resides 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).
Low SIgA
Increasesthe risk of GI infections including SIBO
Low SIgA Causes
Stress
NSAIDs
Antibiotics
How to increase SIgA
- Address stress.
- Saccharomyces boulardii (a non pathogenic yeast).
- Mushrooms (esp. medicinal varieties due to the ↑ beta glucans).
- Vitamin A (needed for the transport of SIgA over the mucosal lining).
- Vitamin D3 (upregulates SIgA expression).
- Polyphenols
- Chlorella.
- Probiotics and prebiotics.
- Echinacea spp.
Elimination Diet
The elimination diet is the most cost
effective way of identifying a food allergy or intolerance.
* It involves first removing the suspected
food(s) from the diet for a period of time
and monitoring any change in symptoms.
* The potential offending food is then
reintroduced and symptoms are monitored
to confirm sensitivity.
* Any food is capable of causing an immune
reaction but the most common problematic
foods are gluten and dairy, corn and soy, eggs, nuts, beef, pork, yeast, citrus, nightshades, chocolate and coffee.
Stage 1 (days 1-2): Detox
- Increase fruits, vegetables, gluten free wholegrains, healthy fats, water intake, herbal teas.
- Remove processed foods, confectionary, chocolate, additives, caffeine, etc.
Stage 2 (days 3 - 14): Elimination
Above, plus remove all suspected foods for 2 weeks (can be done one at a time). If symptoms don’t improve by 3rd week consider other possible triggers.
Stage 3 (days 15 onwards): Reintroduction
- Eat the ‘challenge’ food 2-3 times a day for 1-3 days.
- If you notice any symptoms, remove the food and wait for symptoms to completely disappear before challenging the next food.
- If the food does not cause a reaction, it is safe to keep in your diet for the rest of the programme.
- If a food causes a reaction, keep out of the diet for 3 months before challenging again.
The 5R Protocol
The 5R protocol adopts a structured approach to GI dysfunctions by
asking a client with GI related complaints 5 questions: Remove, Replace, Reinoculation, Repair, Rebalance
The 5R Protocol: 1. Remove
- Foods may be the most important offending agents.
– Remove dietary irritants; i.e., processed
food, food additives, sugar, alcohol, caffeine etc.
– Personalised diet; i.e., remove food allergens / foods that trigger an intolerance (e.g., dairy, gluten), low FODMAP, low histamine, specific carbohydrate diet etc. - Avoid toxins; i.e., pesticides (eat organic), plastic / tinned packaging, non filtered / distilled water, chemically laden beauty products.
- Avoid unnecessary drugs; (e.g., NSAIDs) which can damage the GI mucosa / function.
- Eliminate potentially pathogenic bacteria, viruses, fungi and parasites using antimicrobials specific to the infection
The 5R Protocol: 2. Replace
Replenish digestive factors that may be lacking.
* Stomach acid secretions e.g., digestive bitters, betaine HCl.
* Pancreatic support e.g., bitters, pancreatic enzymes, plant based enzyme formulas, less frequent meals.
* Bile support e.g., choleretics / cholagogues, ox bile.
The 5R Protocol: 3. Reinoculation
Help beneficial bacteria flourish.
* Probiotics: Cultured vegetables, fermented foods and drinks (such as sauerkraut, kimchi, kefir), probiotic supplements e.g., Lactobacillus and Bifidobacterium spp
* Prebiotics: Foods rich in fructans, fructooligosaccharides (FOS), inulin e.g., chicory, leeks, onions, Jerusalem artichokes.
The 5R Protocol: 4. Repair
Regeneration of the GI mucosa.
* For epithelial and tight junction support: L-glutamine, N-acetyl glucosamine, quercetin, zinc, EFAs(incl. EPA / DHA), B vitamins, vitamin A, collagen, bone broth, aloe vera (↑fibroblast collagen synthesis and inhibits COX).
* Supporting the mucous barrier: Demulcent herbs rich in mucilage. slippery elm, liquorice, marshmallow root. Fibre. Polyphenols
* Increase SIgAwhere needed (e.g., S. boulardii) and reduce inflammation (e.g., curcumin).
The 5R Protocol: 5. Rebalance
What lifestyle changes may be needed to support gut healing? (e.g., stress reduction, addressing work / life balance)
Anti-microbial herbs
Berberine
Garlic
Oregano
Uva ursi
Anti-bacterials
Berberine
Garlic
Oregano oil
Neem.
Anti-parasitics
Black walnut hulls
Wormwood
Oregano
Neem
Clove buds
Pumpkin seeds.
Anti-fungals
Caprylic acid
Grapefruit seed extract
Garlic.
Anti-viral
Olive leaf extract
Nano silver
Elderberry.
