Nutrition Based Gastrointestinal Function Dysfunction

Nutrition Based Gastrointestinal Function/Dysfunction Autism One 2006 Conference - Chicago Peta Cohen, MS RD 11 North Dean Street Englewood, NJ 07631 (201) 541-7601 May 26, 2006 Nutrition/Gastrointestinal Related Symptoms   Low oral motor tone Dysmotility    Reflux Constipation Diarrhea     Maldigestion Malabsporption Leaky Gut Dysbiosis   Bacterial Yeast   Gas Altered Stools Peta Cohen, MS, RD 2 Nutrition/Gastrointestinal Based Behaviors             Food aversions/avoidance/cravings PICA Posturing “Drunken stupor” Poor proprioception Toe walking/wide flat gait Self-stimulatory behavior, scripting Aggression toward self & others Altered sleep Hyperactivity/sensory seeking behaviors Lethargy Anxiety/depression/irritability Peta Cohen, MS, RD 3 GI Facts      Mouth to anus the GI tract is about 30 feet Small intestine is approximately 25 feet Surface area of SI equates to that of a tennis court SI is primary site of chemical digestion The epithelial layer of the GI is replaced every 4 days   GI tract is host to 80% of body’s total immune system  GALT/MALT 100 trillion organisms    Gut ecology  Enteric nervous system is larger than CNS Vitamin synthesis   Space between cells referred to as tight junctions Vitamin K Biotin Metallothionein proteins 4  First pass/Phase 3 Detox  Peta Cohen, MS, RD GI FACTS Two types of digestion  Mechanical   Chewing, swallowing Peristalsis HCL, Sodium bicarbonate Enzymes   Chemical   Function is pH sensitive Accessory organs support gut function  Pancreas  Liver  Gallbladder Peta Cohen, MS, RD 5 Gastrointestinal Function Sequence of Events Ingestion >> chewing & moistening of food >> swallowing >> peristalsis >> acidifying >> initiation of protein digestion >> neutralization >> digestion >> absorption >> assimilation >> fermentation & putrification >> elimination Peta Cohen, MS, RD 6 Maldigestion The inability to adequately digest ingested food due to    Insufficient enzyme production Inadequate contact between enzymes and food Inappropriate pH Assessment  Observation of stool   Presence of undigested food particles Floating stool Chymotrypsin, Pancreatic elastase Long chain fatty acids Meat and vegetable fibers  CDSA    Natural Remedies    Digestive enzymes Proteases, Lipase, Carbohydrate enzymes Betaine HCL, Sodium Bicarbonate Peta Cohen, MS, RD 7 Dysmotility - Reflux Symptoms  Frequent ear and upper respiratory infections  Night time waking  Chronic cough  Food avoidance  Aggression/irritability Dietary Recommendations  Avoid trigger foods  Small frequent meals  Promote adequate digestion Peta Cohen, MS, RD 8 Dysmotility - Reflux Pharmaceutical Interventions  Proton pump inhibitors/H2 antagonist  Bethanacol Natural Remedies  Glutamine, DGL, Aloe, Mastica, Slippery elm, Marshmallow root  Investigate food allergies, leaky gut, dysbiosis, H. Pylori Peta Cohen, MS, RD 9 Dysmotility - Constipation Symptoms  Large hard stools  Small pebbles/pellets  Infrequent stools  Very dry stools  Straining to eliminate  Foul breath/body odor  Bloated belly  Gas  Irritability, “spaciness” Peta Cohen, MS, RD 10 Dysmotility - Constipation Dietary Recommendations  Increase intake     Pharmaceutical Interventions     Fruits (be careful with dysbiosis) Vegetables Fiber  Flaxseed Water Essential Fatty acids Fluids  Enema Glycerin suppository Benefiber Laxative  Miralax (polyethylene glycol)  Fat  Peta Cohen, MS, RD 11 Dysmotility - Constipation Natural Remedies  Investigate opioid excess, food allergies, dysbiosis  Aloe  Buffered C  Magnesium citrate  NAG  EFAs Peta Cohen, MS, RD 12 Dysmotility - Diarrhea Symptoms       Frequent stool Loose stool  Liquid to mooshy Very odorous stool Yellow, green and other color stool Urgent stool Soiling Dietary Recommendation   Address  food allergies/sensitivities, dysbiosis, maldigestion, malabsorption GFCF, corn and soy free, allergen free, SCD, BED, LOD Initiate the right diet  Peta Cohen, MS, RD 13 Dysmotility - Diarrhea Pharmaceutical Interventions   Address  Maldigestion, malabsorption, inflammation, dysbiosis Anti-inflammatories, Anti-fungals, Antibiotics, Anti-parasitics, Secretin Treat with  Natural Remedies     Dietary fiber  Benefiber Lipase, proteases, carbohydrate digesting Lactobacillus, Bifido bacteria, Sacchromyces Boulardi Oregano oil, Berberine, Garlic, Grapefruit see extract, Caprylic acid, Essential Oils, Undecylinic acid, Plant tannins, Digestive enzymes  Probiotics/prebiotics  Botanical antimicrobials  Peta Cohen, MS, RD 14 Leaky Gut    Increased permeability at the site of the tight junctions, allows for the free passage of endotoxins, microbes and partially digested food Leaky gut occurs as a result of maldigestion, food allergies, dysbiosis, inflammation, and nutrient insufficiencies Contributes toward food sensitivities, inflammation, and infection at a distant site (atopy) Assessment    Food allergy/sensitivity profile Intestinal permeability test History Peta Cohen, MS, RD 15 Leaky Gut Dietary Recommendations     Promote adequate digestion Remove offending foods such as gluten Address oxalates if necessary Supply adequate nutrients – vitamin A, zinc, pantothenic acid, folic acid, glutamine Natural Remedies       N-acetyl glucosamine Glutamine D-glycerrhized licorice (DGL) Slippery elm Marshmallow root Improve sulfation   MSM Glutathione Peta Cohen, MS, RD 16 Dysbiosis Metabolic activity of GI flora  Vitamin synthesis   Biotin Vitamin K   Fermentation of undigested carbohydrates Development of mucosal immunity  Commensal bacteria colonizing in the first 2 years of life provide the environment for immune development     Production of Short chain fatty acids Mucous production Bile acid deconjugation Detoxification  Phase III  Elimination Peta Cohen, MS, RD 17 Dysbiosis  A condition of altered/imbalanced gut flora  Bacterial and fungal  Contributes to disease    Altered nutrition status Altered elimination Altered immune response   Autoimmunity Atopy  Contributes to total body toxic load   Endotoxins Deconjugated toxins Peta Cohen, MS, RD 18 Dysbiosis Assessment    History of antibiotics, steroids, hormone replacement therapy etc. Genetics Illness  HIV, Diabetes, Cancer and chemotherapy, Hypothyroid, Mercury toxicity    Observation and subjective reporting Organic acid test Stool culture Peta Cohen, MS, RD 19 Dysbiosis Treatment      Dietary change  SCD, BED Digestive enzymes Betaine HCL, Sodium Bicarbonate Promote adequate digestion  Improve gut pH  Probiotics  Lactobacillus, Bifido bacteria, Sacchromyces Boulardi Olive leaf extract, Grapefruit seed extract, Plant tannins, Garlic, Goldenseal, Berberine, Prima Una D’Agato Oil of oregano, Garlic, Grapefruit seed extract, Caprylic acid, Undecylenic acid, Colloidal silver, Plant tannins, Essential oils, Inulin, FOS Ant-ibacterials   Anti-fungals   Prebiotics  Peta Cohen, MS, RD 20 Inflammation  First line of defense of the immune system   Cell mediated immunity – TH1 activation Humoral immunity – TH2 activation Cell or tissue damage Increased permeability Infectious process  Neutrophils are mobilized and activated in the gut due to    Assessment   Endoscopy, Colonoscopy CDSA  Calprotectin Peta Cohen, MS, RD 21 Inflammation Dietary Recommendations   Eliminate allergenic and other offending foods Choose the right diet  GFCF, corn and soy free, SCD, BED, LOD Pharmaceutical Interventions    Steroids 5 ASA drugs Singulair Use natural anti-inflammatories  Natural Remedies     Quercetin, Bromelain, Prima Una D’Agato, Boswellia Serrata, EFAs Digestive enzymes Promote adequate digestion  Address Leaky gut Treat Dysbiosis Peta Cohen, MS, RD 22 Dietary Modification  Clean up the diet       Organic, fresh seasonal foods, Avoid hydrogenated fats Avoid high fructose corn free Avoid artificial sweeteners Avoid dyes and flavors Avoid preservatives       GFCF Corn and soy free Allergen specific free SCD BED LOD Peta Cohen, MS, RD 23 Nutrient Supplementation Supply adequate amounts of  Consider Additional Therapies             Minerals Vitamins Essential fatty acids Antioxidants Digestive enzymes Immune support nutrients Botanical anti-inflammatories Botanical anti-microbials Probiotics and prebiotics Methylation and sulfation support nutrients Brain support nutrients Detoxification support nutrients    PK flush Chelation Far Infra Red Saunas HBOT Peta Cohen, MS, RD 24 Thank You! Peta Cohen, MS, RD 25