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Clinical Nutritionist and Functional Medicine Practitioner

DIGESTION:THE OVERLOOKED GATEWAY TO OPTIMAL HEALTH

Digestion: The Overlooked Gateway

What You Will Learn

• How did we learn how to

digest

• The digestive process

• Key factors for optimal digestion

• What is leaky gut?

• How to heal the gut


Force Multipliers


Powerful ToolsHOW DID WE LEARN HOW TO DIGEST?


A Journey Through TimeMACRO

2.6M - 8000 B.C. 1870 1917 1940 Today


A Journey Through TimeMICRO

18-24 hoursPre-meal Hour 1

THE DIGESTIVE PROCESS


Digestive Illness on the Rise

Ashton JJ, Cullen M, Afzal NA, et al Is the incidence of paediatric inflammatory bowel disease still increasing? Archives of Disease in Childhood 2018;103:1093-1094.


The Digestive Process


Food Into Human


GI Surface

• Largest surface area that

interacts with the environment

• Nutrient absorption and host

defence collide

Digestion: The Overlooked Gateway Digestion: The Overlooked Gateway

Complex Ecological Network

• Proper pH

• Smooth muscle tone

• Stomach acid

• Pancreatic enzymes

• Bile

• GI mucosa

• Microbiome

• Immune system

• Lifestyle


The Father of Medicine

Bad digestion is the root of all evil.

HIPPOCRATES

WHERE DOES IT ALL BEGIN?


The Cephalic Phase of Digestion

• Conditioned reflex

• 20-50% gastric secretions

and hormones


Nervous system

Nervous System


Nervous system

Nervous System

Peripheral Central


Nervous system

Nervous System

Peripheral Central

Autonomic Somatic


Nervous system

Nervous System

Peripheral Central

Autonomic Somatic

Sympathetic Parasympathetic


The Second Brain

• The gut has more nerve

endings than the spine

• 90% of all serotonin is made

in the gut

• 40-50% of total NE occurs in

mesenteric organs


Vagus Nerve“THE WANDERER”


Vagus Nerve Stimulation

• Deep breathing

• Meditation

• Gargling

• Singing loudly

• Gagging

• Coffee enemas

Kharrazian, Datis. Why My Brain Isn’t Working. 2013.

Advanced Clinical Focus:Mental Health and Neurology

NEURONS THAT FIRE TOGETHER, WIRE TOGETHER

JoshGitalis.com

ACTION STEPS


1. Ensure you are in rest and digest mode before, during, and

after a meal

FOOD ENTERS THE BODY


There Are No Teeth in Your Stomach

• Mechanical breakdown

• Plant enzymes released

• Salivary amylase and lipase

• Nitrate-reducing bacteria

HORACE FLETCHER


Importance of Oral FloraCONVERSION TO NITRIC OXIDE

Bacteria in the mouth convert nitrates into nitrite then bioactive circulating nitric oxide.

“Excessive use of antiseptic mouthwashes may attenuate the bioactivity of dietary nitrate.”


Oral Microbiota and Kissing

RESEARCH Open Access

Shaping the oral microbiota through intimatekissingRemco Kort1,2,3*, Martien Caspers1, Astrid van de Graaf2, Wim van Egmond2, Bart Keijser1 and Guus Roeselers1

Abstract

Background: The variation of microbial communities associated with the human body can be the cause of manyfactors, including the human genetic makeup, diet, age, surroundings, and sexual behavior. In this study, we investigatedthe effects of intimate kissing on the oral microbiota of 21 couples by self-administered questionnaires about their pastkissing behavior and by the evaluation of tongue and salivary microbiota samples in a controlled kissing experiment. Inaddition, we quantified the number of bacteria exchanged during intimate kissing by the use of marker bacteriaintroduced through the intake of a probiotic yoghurt drink by one of the partners prior to a second intimate kiss.

Results: Similarity indices of microbial communities show that average partners have a more similar oralmicrobiota composition compared to unrelated individuals, with by far most pronounced similarity for communitiesassociated with the tongue surface. An intimate kiss did not lead to a significant additional increase of the averagesimilarity of the oral microbiota between partners. However, clear correlations were observed between the similarityindices of the salivary microbiota of couples and self-reported kiss frequencies, and the reported time passed after thelatest kiss. In control experiments for bacterial transfer, we identified the probiotic Lactobacillus and Bifidobacteriummarker bacteria in most kiss receivers, corresponding to an average total bacterial transfer of 80 million bacteria perintimate kiss of 10 s.

Conclusions: This study indicates that a shared salivary microbiota requires a frequent and recent bacterial exchangeand is therefore most pronounced in couples with relatively high intimate kiss frequencies. The microbiota on thedorsal surface of the tongue is more similar among partners than unrelated individuals, but its similarity does notclearly correlate to kissing behavior, suggesting an important role for specific selection mechanisms resulting from ashared lifestyle, environment, or genetic factors from the host. Furthermore, our findings imply that some of thecollective bacteria among partners are only transiently present, while others have found a true niche on the tongue’ssurface allowing long-term colonization.

Keywords: Intimate kiss, Oral microbiota, Tongue, Saliva, Next generation sequencing, Streptococcus, Lactobacillus

BackgroundMouth-to-mouth contact has been observed in a widevariety of animals, including fish, birds, and primatesand serves a range of functions, including the assess-ment of physical abilities and the acquirement of food.However, intimate kissing involving full tongue contactand saliva exchange appears to be an adaptive courtshipbehavior unique to humankind and is common in over

90% of known cultures, as reported in [1] and referencesherein. Interestingly, the current explanations for thefunction of intimate kissing in humans include an im-portant role for the microbiota and viruses present inthe oral cavity, although to our knowledge, the effects ofintimate kissing on the oral microbiota have never beenstudied to date.A recent study on the importance of kissing in human

mating situations proposes that the first kiss serves as auseful mate-assessment function and the following formediation of feelings of attachment in long term rela-tionships, rather than the facilitation of sexual arousal[1]. Kissing may contribute in mate assessment andbonding via sampling of chemical taste cues in the saliva

* Correspondence: [email protected] Microbiology and Systems Biology, Utrechtseweg 48, 3704 HE Zeist,The Netherlands2Micropia, Natura Artis Magistra, Plantage Kerklaan 38-40, 1018 CZAmsterdam, The NetherlandsFull list of author information is available at the end of the article

© 2014 Kort et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly credited. The Creative Commons Public DomainDedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,unless otherwise stated.

Kort et al. Microbiome 2014, 2:41http://www.microbiomejournal.com/content/2/1/41

Kort et al. Microbiome 2014, 2:41

80 million bacteria transferred in a 10 second kiss.


What Needs To Be Digested?MACRONUTRIENTS

CARBOHYDRATES PROTEIN FAT

Loomis, Howard F. Enzymes: The Key to Health. Grate Publishing, 2007.


PredigestionMACRONUTRIENTS

60% OF CARBOHYDRATES + 30% OF PROTEIN + 10% OF FAT + _____________________________

1/3 OF DIGESTION

Loomis, Howard F. Enzymes: The Key to Health. Grate Publishing, 2007.


Gastric Acid

• Parietal cells

• Proton pump

• pH 1.5 - 3.5


Discover Gastric Acid

• Alexis St. Martin

• 200 experiments over 10

years

DR. WILLIAM BEAUMONT


With Sufficient HCl

• Tissues softened

• Microorganisms sterilized

• Food in stomach 30 min - 2h


Digestive Cascade

• Beginning of the digestive

cascade

• Ionizes minerals

• Activates pepsin

• Sterilizes

Rafsky HA, Weingarten M. A study of the gastric secretory response in the aged. Gastroenterol. 1946;8:348-352. Davies D, James TG. An investigation into the gastric secretion of a hundred normal persons over the age of sixty. Brit J Med. 1930;i:1-14


Declines With AgeSTOMACH ACID

Why Stomach Acid Is Good for You: Natural Relief from Heartburn, Indigestion, Reflux and Gerd. Jonathan V. Wright. M. Evans and Company 2001


Ionization of Minerals


Ionization of Minerals

KCl

STOMACH ACID

K+ and Cl- Absorption


Hypochlorhydria: Disease Associations

• Addison’s • Asthma

• Celiac

• Autoimmune

• Hives • Dermatitis

• Diabetes

• Eczema

• Gallbladder

disease

• Graves • Hepatitis

• Thyroid issues

• Lupus

• Myasthenia gravis

• Osteoporosis

• Pernicious

anemia

• Psoriasis

• Rheumatoid arthritis

• Rosacea

• Sjogren’s

syndrome • Thyrotoxicosis

• Vitiligo

Indigestion, Antacids, Achlorhydria and H. Pylori. American Journal of Natural Medicine. (Jan-Feb 1997): 11-16


• Bloating, burping, burning

and flatulence

immediately after meals

• Fullness

• Feeling as though food

sits for hours

• Indigestion, diarrhea, or

constipation

• Food allergies

• Nausea after taking

supplements

• Itching around rectum

• Weak nails

• Dilated blood vessels in

cheeks


Hypochlorhydria: Clinical Cues


Hypochlorhydria: Clinical Cues

• Acne

• Iron deficiency

• Chronic parasite/

infection

• Undigested food in stool

• Chronic candida

• Upper GI gas



Misdiagnosis?

But that sounds like too much

stomach acid!


Misdiagnosis?

Rx Antacids


Antacid Complications

• Clostridium difficile

• Malabsorption of Ca, Fe, B12

• Renal failure

• Cardiovascular events

• Hip fractures

Howel MD et al. Iatrogenic Gastric Acid Suppression and the Risk of Nosocomial Clostridium difficile Infection. Arch Intern Med. 2010;170(9):784-790. Malfertheiner, P., et al. (2007). Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut, 56(6), 772–781. Recker, R. R. (1985). Calcium absorption and achlorhydria. N Engl J Med, 313(2), 70–73. Geevasinga, N., et al. (2006). Proton pump inhibitors and acute interstitial nephritis. Clin Gastroenterol Hepatol, 4(5), p. 597–604. Juurlink, D. N., Gomes, T., Ko, D. T., et al. (2009). A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ, 180(7), 713–718. Yang, Y. X., Lewis, J., Epstein, S., Metz, D. (2006). Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA, 296, 2947–2953.


Gastric Acidity and Allergy

• Gastric digestion decreases

food allergy

• 10-30x higher tolerated

allergen dose if the fish

proteins were previously

subjected to in vitro gastric

digestion

Untersmayr, E and Jensen-Jarolim, E. The role of protein digestibility and antacids on food allergy outcomes. J Allergy Clin Immunol. 2008 June; 121(6):1301-1310



• The gatekeeping function of

the stomach in the

sensitization and effector

phase of food allergy



• The gatekeeping function of

the stomach in the

sensitization and effector

phase of food allergy




Gastric Enzymes

• Reducing allergenicity of

melon allergens after

incubation with gastric

enzymes



Heidelberg pH Capsule Test

NORMAL HEIDELBERG GASTROGRAM ACHLORHYDRIC GASTROGRAM


Treating Low Stomach Acid

• Rest and digest

• Chew

• Stomach acid repletion

protocol

• Bitters


Decrease HCl Requirements

• Lemon juice or ACV

• Smaller meals

• Limit mealtime fluid

ACTION STEPS


1. Ensure you are in rest and digest mode before, during, and after a

meal

2. Address low stomach acid, and provide support if needed

LEAKY GUT


Immunity in the Gut

Death begins in the colon.

ELIE METCHNIKOFF


Leaky GutWHAT IS IT?

• Small intestine gets

damaged allowing larger

molecules into the

bloodstream


Leaky GutCAUSES

• Drugs

• Dysbiosis

• Infections, parasites

• Stress

• Alcohol

• Allergies

• Food

C. Sostres, C. J. Gargallo, and A. Lanas, “Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage,” Arthritis Research & Therapy 15, suppl. 3 (2013): S3.


Antibiotics

• Upset gut flora

• Predisposes to IBS

Gut. 2006;55:182-190. Am J Gastroenterology. 2002;97:104-108. Eur J Gastroenterol Hepatol. 1998;10:59-62.


Antibiotics and Gut Flora

Altern Med Rev. 2004;9:180-197


Antibiotics, Flora, and Probiotics

Red area = AxBlue line = No interventionRed line = SB with AxGreen line = SB after AxBlack dotted = SB during and after

(SB = Saccharomyces Boulardii)

Clin Exp Gastroenterol. 2015; 11:237-255.


Psychological Stress and InflammationBRAIN-GUT AXIS

Mawdsley J E, Rampton D S Gut 2005;54:1481-1491


Stress Causes Changes

• Suppresses lactobacilli,

bifidobacteria

• Suppresses sIgA

• Stimulates growth of

pathogenic bacteria (yersinia

pseudomonas)

• Anger and fear increase

bacteroides fagilis

Developmental Psychology 1999;35;2:146-155


AlcoholINCREASES LEAKINESS

The Toxin Solution. How Hidden Poisons in the Air, Water, Food, and Products We Use Are Destroying Our Health. Joseph Pizzorno


AlcoholINCREASES LEAKINESS

The Toxin Solution. How Hidden Poisons in the Air, Water, Food, and Products We Use Are Destroying Our Health. Joseph Pizzorno


Increase of Allergies1990 - 2001

BMJ 2003;327:1142


Allergies in InfancyWINDOW OF SUSCEPTIBILITY

• Infants gut is leaky

• IgG, IgA, IgM, IgD, IgE in

breast milk

• Gut: up to 970k daltons

• Casein: 121.7k daltons

• Gluten: 150k daltons

Clinical Nutrition: A Functional Approach: 2nd Edition. 2004. pp 202-203


Gut PermeabilityA VICIOUS CYCLE?

“We conclude by speculating on the effect of increased

intestinal permeability on the onset of

sensitization towards dietary antigens.”


Prevent and Treat Allergies

• Eliminate allergens

• Breastfeeding

• Maternal and infant

probiotics

• Maternal and infant

prebiotics


Diet and MicrobiomeSUBTITLE CENTRE

Nutrients 2013, 5, 162-207

“About 75% of the food in the Western diet is of limited or no benefit to the microbiota in the

lower gut.”


One Day Alters MicrobiomeSUBTITLE CENTRE

Turnbaugh PJ et al. Sci Transl Med 2009;1(6):6ra14.

“Remarkably, a clear shift in gene content

was evident 1d after the switch to the Western

diet.”


Diets For GI Healing

• Gluten-Free Casein-Free

• SCD and GAPS

• FODMAPs

• Comprehensive elimination

• Anti-fungal

• Anti-inflammatory

• Restoration

• Paleo/AIP

• Ketogenic


What Do These All Have in Common?

Elimination

No processed foods

No refined sugar

Good fats

ACTION STEPS



after a meal


3. Manage factors that cause leaky gut

GLUTEN


Gluten


What is Gluten?

• A protein that occurs in

certain grains


Which Grains Have Gluten?

• Wheat

• Rye

• Barley

• Kamut

• Spelt


Which Grains Don’t Have Gluten?

• Rice

• Corn

• Quinoa

• Teff

• Amaranth

• Millet

• Oats


Why Are We So Sensitive to Gluten?THE PERFECT STORM

• Wheat hybridization

• Increase chemicals

• Gut issues

• High stress

• Cooking methods

• Amount consumed


Gluten-Related Symptoms

Nat Rev Gastroenterol Hepatol. May 2012;9(5):295-299.


Gluten-Related Symptoms

Nat Rev Gastroenterol Hepatol. May 2012;9(5):295-299.

Digestive Other


Wheat

EINKORN 14 CHROMOSOMES

DWARF 42 CHROMOSOMES


It’s Not Just Gluten

Illustrations dramatized for visual purpose.Image property of Cyrex Labs. © 2017 Cyrex Laboratories, LLC. All rights reserved. A3BRO-05172017

Wheat

w-Gliadin-17-mer

a-Gliadin-17-mer

Native + Deamidated

a-Gliadin-33-mer

Glutenin-21-mer

Gluteomorphin

Prodynorphin

Wheat Germ

Agglutinin

Gliadin-Transglutaminase

Complex

Transglutaminase-2 Transglutaminase-3 Transglutaminase-6

g-Gliadin-15-mer

Opioid

Peptides

Lectin

enzymes

Wheat

Proteins • PePtides

GlutenGluten

Opioid Peptides

IS GLUTEN BAD FOR EVERYONE?


Gluten

“The data obtained in this pilot study support

the hypothesis that gluten elicits its harmful

effect…on all the individuals.”


Nutrients 2013, 5, 771-787; doi:10.3390/nu5030771

nutrients ISSN 2072-6643

www.mdpi.com/journal/nutrients Review

The Dietary Intake of Wheat and other Cereal Grains and Their Role in Inflammation

Karin de Punder 1 and Leo Pruimboom 1,2,*

1 University of Girona, Plaça Sant Domènec, 3 Edifici Les Àligues, 17071 Girona, Spain; E-Mail: [email protected]

2 Uni for Life, University of Graz, Beethovenstraβe 9, 8010 Graz, Austria

* Author to whom correspondence should be addressed; E-Mail: [email protected].

Received: 17 December 2012; in revised form: 8 February 2013 / Accepted: 21 February 2013 / Published: 12 March 2013

Abstract: Wheat is one of the most consumed cereal grains worldwide and makes up a substantial part of the human diet. Although government-supported dietary guidelines in Europe and the U.S.A advise individuals to eat adequate amounts of (whole) grain products per day, cereal grains contain ―anti-nutrients,‖ such as wheat gluten and wheat lectin, that in humans can elicit dysfunction and disease. In this review we discuss evidence from in vitro, in vivo and human intervention studies that describe how the consumption of wheat, but also other cereal grains, can contribute to the manifestation of chronic inflammation and autoimmune diseases by increasing intestinal permeability and initiating a pro-inflammatory immune response.

Keywords: cereal grains; celiac disease; gluten; gliadin; inflammation; intestinal permeability; lectins; wheat; wheat germ agglutinin

1. Introduction

Inflammation is the response of the innate immune system triggered by noxious stimuli, microbial pathogens and injury. When a trigger remains, or when immune cells are continuously activated, an inflammatory response may become self-sustainable and chronic. Chronic inflammation has been associated with many medical and psychiatric disorders, including cardiovascular disease, metabolic syndrome, cancer, autoimmune diseases, schizophrenia and depression [1–3]. Furthermore, it is usually associated with elevated levels of pro-inflammatory cytokines and acute phase proteins, such

OPEN ACCESS

Gluten

“…the daily consumption of wheat products and

other related cereal grains could contribute to the manifestation of chronic inflammation

and autoimmune diseases.”


Gluten

Nutrients 2015, 7, 1565-1576; doi:10.3390/nu7031565

nutrients ISSN 2072-6643

www.mdpi.com/journal/nutrients Article

Effect of Gliadin on Permeability of Intestinal Biopsy Explants from Celiac Disease Patients and Patients with Non-Celiac Gluten Sensitivity

Justin Hollon 1,*, Elaine Leonard Puppa 2, Bruce Greenwald 3, Eric Goldberg 3, Anthony Guerrerio 4 and Alessio Fasano 5

1 Department of Pediatric Gastroenterology, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA

2 University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mail: [email protected]

3 Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; E-Mails: [email protected] (B.G.); [email protected] (E.G.)

4 Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; E-Mail: [email protected]

5 Center for Celiac Research, Massachusetts General Hospital and Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital for Children, Boston, MA 02114, USA; E-Mail: [email protected]

* Author to whom correspondence should be addressed; E-Mail: [email protected]; Tel.: +757-953-4529; Fax: +757-953-3293.

Received: 28 October 2014 / Accepted: 11 February 2015 / Published: 27 February 2015

Abstract: Background: Intestinal exposure to gliadin leads to zonulin upregulation and consequent disassembly of intercellular tight junctions and increased intestinal permeability. We aimed to study response to gliadin exposure, in terms of barrier function and cytokine secretion, using intestinal biopsies obtained from four groups: celiac patients with active disease (ACD), celiac patients in remission (RCD), non-celiac patients with gluten sensitivity (GS) and non-celiac controls (NC). Methods: Ex-vivo human duodenal biopsies were mounted in microsnapwells and luminally incubated with either gliadin or media alone. Changes in transepithelial electrical resistance were monitored over 120 min. Media was subsequently collected and cytokines quantified. Results: Intestinal explants from all groups (ACD (n = 6), RCD (n = 6), GS (n = 6), and NC (n = 5)) demonstrated a greater increase in

OPEN ACCESS

“Increased intestinal

permeability after gliadin exposure

occurs in all individuals.”


Gluten and Leaky GutMECHANISM

SCIENTIFIC AMERICAN. August 2009. Volume 301, Issue 2

ACTION STEPS



after a meal



4. Eliminate gluten

HOW ELSE CAN WE SUPPORT THE GUT?

Functional Reset Program

Functional FoodsFOOD FOR HEALING


Mucilaginous Foods/Herbs

• Flax seed

• Chia seeds

• Aloe vera

• Okra

• Slippery elm

• Marshmallow root

"Relax, sir. The hair in your soup provides fibre.”


Bone Broth

• Gelatin

• Amino acids

• Ca, Mg, P, K

• Glycinate

• Proline

• Hyaluronic acid

• Chondroitin sulfate


Probiotics

• Kimchi

• Sauerkraut

• Kombucha

• Yoghurt

• Kefir

• Pickles

• Miso


Prebiotics

• Inulin: onions, chicory,

dandelions

• Oligosaccharides:

artichokes, leeks, asparagus

• Beta-glucan: seaweed, oats,

mushrooms

• Pectin: apples, apricots

• Resistant starch: bananas,

potatoes


Digestive Stimulation from Spices

Pancreatic Amylases Lipase Activity Disaccharides At least one

disaccharase

•Ginger •Turmeric

•Turmeric •Coriander (nearly 300%) •Onion

• Ginger • Fennel • Cumin • Turmeric • Capsaicin (cayenne) • Piperine (black pepper)

Adapted from Platel & Srinivasan, 2004; Indian J Med Res, 119, 167-179. Review Article: Digestive stimulant action of spices: A myth or reality?


Digestive Stimulation from Herbs

• Globe artichoke

• Dandelion root

• Gentian

• Chamomile

• Turmeric

• Ginger

Ailment Pharmacol Ther 18 (2003): 1099-105. Fitoterapia 75.7–8 (2004): 760–3. Current Therapeutic Research 1981;29:525-536. Mol Med Report. 2010 Nov 1;3(6):895-901. J Altern Complement Med 10.6 (2004): 1015–18. Dig Dis Sci 50.10 (2005): 1889–97.


Digestive Supportive Supplements

• L-Glutamine

• Zinc Carnosine

• Probiotics/Prebiotics

• Betaine HCl

• Enzymes

• Antimicrobials

ACTION STEPS


1. Ensure you are in rest and digest mode before, during and

after a meal



4. Eliminate gluten

5. Heal the gut


Powerful Tools

THANK YOU!: JoshGitalis: JoshGitalisClinicalNutritionist: JoshGitalis.com

The Functional Nutrition Certifi cation Program bridges

the gap between theory and practice. Explore the root cause

of illness, and the foundation of health from an evidence-based

perspective. Dive deep into key body systems and discover how

to restore balance with targeted therapeutic interventions.

Functional Nutrition Training

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clinical nutritionist and functional medicine practitioner...mediation of feelings of attachment in...

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