Gastrointestinal Balance:
Do you have the guts for health?
Mark Pettus MD, FACP
February 18, 2014
I want to achieve immortality not through my
work … I want to achieve it through not dying.
Woody Allen
The Proposition
• All health and disease are byproducts of complex individualized geneenvironment interactions that may go back more than a generation
before conception and continue throughout our lives.
• Your genes i.e., your “Book of Life” have a Stone Age imperative, not
often compatible with 21st century environmental inputs.
• This incompatibility creates a distorted metabolic trajectory that forms
the basis of chronic complex disease.
• Through epigenomic alteration, our gene expression patterns can be
profoundly modulated to promote optimal function and health.
• This remains possible throughout life by aligning one’s environmental
inputs with that which your genes are best suited for…this is the exit to
a healthy life.
Learning Objectives
 Examine the role that gastrointestinal health plays in the
broader context of health, dis-ease, and quality of life.
 Explore the connection between gastrointestinal health,
your gut’s ecosystem, inflammation-immune regulation,
and your nervous system.
 Examine environmental inputs that lead to “leaky-ness” or
increased permeability in the gut.
 Review the “4R-Model” for gastrointestinal health
Digestive Disease in America
Impacts 60-70% Americans
GERD effects 45-60 million
7-10% Americans experience heartburn at least daily
20% (60 million) experience at least once monthly
Irritable bowel disease (IBS) effects 30-45 million
Gallstone disease 20-25 million
Diverticular Disease 20 to 40 million
Celiac estimated at 3 million (approx 1:100)
Gluten sensitivity as much as ? 10% of Americans
IBD 750,000 – 1 million
Colorectal Cancer approximately 260,000
The IMS reports that Americans spent $307 billion on
prescription drugs in 2010. The 10 drugs on which we
spent the most were:
•Lipitor, a cholesterol-lowering statin drug -- $7.2 billion
•Nexium, an antacid drug -- $6.3 billion
•Plavix, a blood thinner -- $6.1 billion
•Advair Diskus, an asthma inhaler -- $4.7 billion
•Abilify, an antipsychotic drug -- $4.6 billion
•Seroquel, an antipsychotic drug -- $4.4 billion
•Singulair, an oral asthma drug -- $4.1 billion
•Crestor, a cholesterol-lowering statin drug -- $3.8 billion
•Actos, a diabetes drug -- $3.5 billion
•Epogen, an injectable anemia drug -- $3.3 billion
Gut Health
Immune/Inflammation
Mind-Brain-Body
Problems with gut health can promote/worsen…
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Allergy
Asthma
Autoimmunity
Arthritis
Metabolic Bone disease
Skin problems
Mood disorders
Dementia
Cancer
Inflammation
IBS associated with:
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GERD
Interstitial cystitis
Fibromyalgia
Chronic Fatigue Syndrome
Disrupted sleep
Rosacea
Migraine headaches
Restless leg syndrome (RLS)
GERD: Do we have all wrong?
Celiac and gluten sensitivity associated with:
Thyroid disease
Neurologic diseases
Osteoporosis
Decreased fertility
Recurrent UTIs
Autoimmune disease
Skin disorders e.g. eczema, rosacea
RLS – restless leg syndrome
David Relman MD
Clin Prof Med-ID, Prof
Microbiology-Immunology
Stanford
Ecology of human
indigenous microbiology
and relationship to health
and disease.
Irritable Bowel Syndrome
Most common GI functional disorder diagnosed by gastroenterologists affecting about
5-10% of the population with female predominance of 2-3:1
Symptom complex including abdominal pain, altered bowel function, bloating, mucosal
inflammation, exaggerated stress response, increases in plasma pro-inflammatory
cytokines
Stress (including early life stress) plays a major role in the onset
and exacerbation of symptoms in IBS
Recent studies have shown that there may be a
brain-gut axis dysfunction involved in IBS
Treatment options for IBS are symptom based and include:
– Laxatives
– Loperamide (Imodium)
– Antispasmodics
– Antidepressants
– Serotonin receptor agonists/ antaginsts
Increased Intestinal Permeability
And molecular trafficking
Common causes of increased intestinal permeability
 SAD: High animal fat, animal protein, high-sugar, low-fiber,
processed diet
 Overuse of medications such as NSAIDs, antibiotics, acid blockers,
steroids e.g. prednisone, chemotherapy
 Food sensitivities - allergies
 Low-grade bug imbalances (dysbiosis) involving yeast, bacterial
overgrowth (SIBO)
 Toxins e.g. BPA, pthalates, pesticide residues
 Stress or the brain-gut connection
 Alcohol
Stress and the gut
Stress
Activation of the HPA axis
(ie CRF, ACTH, cortisol)
• Increase in gut permeability
• Increase in mucosal inflammation
• Changes in GI motor function
• Changes in gut flora
The 4R Model
Remove
• Foods that one may be intolerant to (elimination diet:
start with gluten and dairy).
• Medications that may negatively influence an optimal
GI environment (such as PPIs, H2 blockers, NSAIDs,
antibiotics, steroids).
• For IBS or persistent dyspepsia, consider SIBO and
treat with xifaxin 200 mg, two tabs twice daily for
10-14 days
• Consider a 2-4 week trial with Diflucan for yeast
• Stress: how we interpret and respond
Replace
For persistent dyspepsia,
indigestion, or long-term use of
stomach acid suppression consider
digestive enzymes to promote better
macronutirent breakdown. These are
usually plant-based (papaya,
pineapple) compounds e.g.
bromelain taken with each meal.
Re-populate
• Administer probiotics from the
following three families that have been
found to be beneficial for GI function:
Bifidobacteria, Lactobacilli, and
Saccharomyces.
• Administer prebiotics (food that
promotes beneficial bacterial growth)
such as bananas, Jerusalem artichoke,
onions, asparagus and garlic, whole
grains.
• Target at least 20-30 billion cfus/day
Repair…nutritionally
Eat whole, fresh, unprocessed foods-seasonal, organic, and
local
Fiber supports gut flora
Avoid common food allergens
Eat foods that taste good and allow your taste buds time to get
used to new foods
Eat in rhythm with meals scheduled at regular intervals
throughout the day
Eat in a mindful, relaxed state
Stay a little hungry
Eat foods YOU prepare
Repair
• Fiber: Consider psyllium or guar gum, 1 tsp in 8-10 oz of water
before each meal if not getting enough fiber.
• Whole Food Nutrition: Incorporate a hypoallergenic, nutrient rich
diet.
• Regular Exercise.
• Zinc carnosine: 25-30 mg a day for one month.
• Omega-3 fatty acids (EPA/ DHA) and/or Gamma Linolenic Acid
(Evening primrose Oil, Borage Oil or Black Currant Oil):Total of
2 gms daily for one month.
• L-Glutamine Powder: 5 gms twice daily for one month.
Relaxation
Supplements with some supportive research
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Aloe Vera juice – 3 oz. twice daily
dgl-Licorice for GERD – 500mg chewtabs with meals
Digestive enzymes – 1-2 caps with meals
O-3 fish oils 4-6 grams/day EPA/DHA
Ginger – 1,000 to 2,000 mg daily
Glutamine 500-1,000 mg with meals
Magnesium citrate or glycinate 400 – 800 mg daily
Melatonin – 3-6 mg at bedtime for GERD
Zinc carnosine 15-30 mg daily
Vitamin D: 1,000 – 4,000 u/day to keep levels 40+
Thank you.