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  Gut ecology  100 trillion organisms   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 Lactobacillus, Bifido bacteria, Sacchromyces Boulardi Olive leaf extract, Grapefruit seed extract, Plant tannins, Garlic, Goldenseal, Berberine, Prima Una D’Agato Promote adequate digestion     Improve gut pH  Probiotics  Ant-ibacterials   Anti-fungals  Oil of oregano, Garlic, Grapefruit seed extract, Caprylic acid, Undecylenic acid, Colloidal silver, Plant tannins, Essential oils, Inulin, FOS  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